Fate of left kidney after left renal vein division during management of aortic occlusive disease.
OBJECTIVE
Left renal vein division (LRVD) has been used as a technical aid to gain exposure to the peri-renal aorta and to control bleeding in abdominal aortic operations. A few retrospective series studied the effects of such division on the overall renal function with contradicting results. The aim of this study was to assess the effect of such division on the left kidney during the management of aortic occlusive disease.


METHODS
A prospective study was undertaken on all patients that had abdominal aortic bypass surgery for juxta-renal aortic occlusive disease scheduled between October 2003 and September 2007. Renal function was assessed by measuring serum creatinine (mg/L+/-SD) and creatinine clearance (mL/min+/-SD) preoperatively and postoperatively up to 14 days in patients who had LRVD and patients who had left renal vein intact (LRVI) which served as control. Left kidney was assessed preoperatively by performing abdominal computed tomography angiography (CTA) and postoperatively with either ultrasonography (US) or CTA depending on the serum creatinine level.


RESULTS
Thirty-two patients were included in this study. Six patients had LRVD. There was no statistically significant difference between the LRVD and LRVI groups as regard mean serum creatinine, preoperatively (LRVD 1.05+/-0.31 vs LRVI 1.08+/-0.21,P=0.38) and XIV day postoperatively (LRVD 1.15+/-0.31 vs LRVI 1.09+/-0.24, P=0.34), and mean creatinine clearance, preoperatively (LRVD 94+/-17.4 vs LRVI 97.9+/-11.1, P=0.31) and XIV day postoperatively (LRVD 88.8+/-13.1 vs LRVI 94.3+/-6.7 p=0.11). CTA and US showed postoperative early diffuse swelling and congestion of the left kidney in 4 cases that had LRVD, which reverted to normal at XIV day postoperatively.


CONCLUSIONS
Selective LRVD during aortic occlusive surgery does not compromise the left kidney.
Elsharawy
M A
MA
Department of Surgery, King Faisal University, Al-Khober, Saudi Arabia. elsharawya@yahoo.co.uk
Moghazy
K M
KM
D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012082:Renal Veins / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods