ARRS 2022 Abstracts

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E1624. When in Doubt, Cut It Out! Left Renal Vein Variants’ Implications on Nephrectomy, IVC Filter Placement, and More
Authors
  1. Rebekah Padilla ; University of Florida College of Medicine
  2. Kate Yacona; Lake Erie College of Osteopathic Medicine
  3. Wen Wang; University of Florida College of Medicine
  4. Efrain Padilla ; HCA Health Care
  5. Sindu Kumar ; University of Florida College of Medicine
  6. Mayur Virarkar; University of Florida College of Medicine
  7. Smita Sharma; University of Florida College of Medicine
Background
Renal vein anomalies are highly variable in terms of level of origin, course, and anastomotic pattern. Recognition of such anomalies prior to surgery or endovascular procedures is critical to avoid inadvertent injuries and complications. Our educational exhibit will discuss imaging modalities to evaluate renal vein variant anatomy, normal renal vein anatomy, and clinical application. We showcase a rare case of circum-aortic left renal vein with anastomosis to the hemiazygos vein.

Educational Goals / Teaching Points
A review of general renal vein anatomy will be presented, focusing on the left renal vein and its variants. Knowledge regarding the morphology and clinical implications of the variant discussed in our presented case as well as other variants are critical to avoid major complications in abdominal surgery. Many may be discovered with MDCT, which has improved the assessment and increased the detection of renal anatomic variations prior organ procurement. Prompt and accurate detection and diagnosis of these renal variants is essential in renal transplant donors and recipients to ensure successful and safe transplant. Diagnosis of left renal vein variants is also needed when evaluating for IVC filter placement, gonadal vein embolization, or in patients with nutcracker syndrome. A review of imaging modalities and renal vein characteristics with case examples will enable the reader to add value to their radiology reports.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Typically, the left renal vein courses anterior to the aorta to the renal hilum and the left gonadal vein typically joins the left renal vein.Left renal vein variants are frequently encountered, and we review imaging modalities to evaluate these findings. On CT with contrast and CTA examinations, variant renal vein anatomy can be imaged adequately prior to surgical intervention. Imaging prior to gonadal vein embolization either for varicoceles or pelvic congestion syndrome in a patient with variant anatomy may help the proceduralist identify the route to take during the procedure. Patients with variant left renal veins may have variant gonadal vein anatomy. CT images without IV contrast did not identify variant renal veins and although large variations may be identified incidentally, preprocedural planning imaging should include IV contrast. Ultrasonography may be useful as a non-invasive modality to assess distended renal veins, such as in cases of nutcracker syndrome. Venography can also be used to identify variant anatomy at the time of endovascular procedure, although selective venography is superior over IVC venography.

Conclusion
Variant vascular anatomy in the body can have significant impact in a patient’s procedural planning. The radiologists' timely identification and communication to the operating surgeon or interventionist is key to increasing the value of radiology reports, increasing patient safety and decreasing preventable complications.