Introduction:
The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically and surgically significant especially in live kidney donor with Nutcracker syndrome.
The objectives of this study are to identify vascular variations associated with Nutcracker syndrome in live donor kidneys, to determine the incidence of this condition, and to assess the feasibility and potential complications of nephrectomy in donors with Nutcracker syndrome.
Methods:
All live donor kidneys and transplanted kidneys from live donors with Nutcracker syndrome identified between February 2009 and December 2022 were evaluated.
Results:
Twenty-two left nephrectomy in live donor kidney with Nutcracker syndrome
were performed with a mean operating time of 190 ±40 minutes. The mean duration of major analgesia was 3.3 days and the mean length of hospital stay was 8.3 days.
- three types of Nutcracker syndrome were identified: in sixteen cases the syndrome was anterior, in FIVE cases was posterior and in one case was mixed.
-concerning the posterior nutcracker syndrome, a short vein was noted with minimal difficulty of anastomosis.
- concerning the mixed type, the retroaortic branch was simply ligated without incidence.
- dissection demonstrated an evidence of Anomalies of the left renal venous drainage system occurred in all patients.
-The multiple lumbar and gonadal veins abnormally dilated, in all patients was the principle constatation and difficulty during the nephrectomy.
-The other anomalies included bifurcation of the gonadal vein, bifurcation of the suprarenal vein, the inferior phrenic vein draining into the left renal vein distal to the superior mesenteric artery.
-Complications in donors were:
Intra-operative blood losses were minimal, except four cases especially due to abnormal lumbar veins. Prolonged lymphorrhoea was the most frequent complication seen in 8 cases. Immediate pulmonary embolism was seen in one case.
Conversion was necessary in one transplanted kidney following large retroperitoneal hematoma due to reopening of a ligated lumbar vein; successfully treated.
With a mean follow-up of 19 months (3 to 39 months), no venous complications have been observed in the transplanted kidneys.
Conclusions:
The anatomy of the left renal vein, especially knowledge of collateral flow, is extremely important to ensure intraoperative security dissection and best preservation of the anatomical structure of the kidney; and allows rapid extraction of the kidney.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.