title: Preoperative evaluation of retroperitoneal venous system anomalies during abdominal aortic aneurysm rupture.
abstract: The association of a retroaortic left renal vein and an abdominal aortic aneurysm (AAA) fistula is an infrequent event. We present two cases of AAA rupture into the retroaortic left renal vein. Preoperative computed tomography (CT) assessment showed retroperitoneal bleeding due to a large AAA rupture with an associated unusual retroaortic left renal vein. Patients underwent successful arteriovenous fistula sutures with abdominal aortoiliac replacement. The patients had uneventful recoveries, and they were discharged on the seventh to ninth postoperative day (POD) without renal complications. The clinical onset was characterized by the unique syndrome: continuous abdominal bruit, abdominal and left flank pain with an associated pulsatile mass (Mansour Triad). Moreover patients presented with haematuria, proteinuria and a large non-functional left kidney on the imaging scan. The CT-scan may suggest the presence of the venous anomaly. Unusual anatomical presentation recommends a careful surgical approach during AAA operations.
authors.affiliation: Department of Vascular Surgery, ASL-RMF S. Paolo Hospital Civitavecchia, and Department of Oncology Policlinico Umberto I Sapienza University of Rome, Rome, Italy. rogadoc@libero.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Gabrielli
authors.forename: Maria Sofia
authors.initials: MS
authors.lastname: Rosati
authors.forename: Andrea
authors.initials: A
authors.lastname: Siani
authors.forename: Giustino
authors.initials: G
authors.lastname: Marcucci
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D000792:Angiography / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012082:Renal Veins / Q000002:abnormalities*; D012187:Retroperitoneal Space; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis*