Long-term Safety of Renal Vein Division and Ligation to Expedite Complex Abdominal Aortic Surgery

BACKGROUND: Division and ligation of the left renal vein is performed to facilitate complex abdominal aortic surgery. Surgeons restore continuity of the vein due to concern that ligation could cause renal compromise or hematuria. However, we report the short and long-term safety of left renal vein division and ligation.
METHODS: Between 1992 and 2007 we divided the left renal vein in 56 patients (40 males, 16 females) age 57-84 years (average 74 years) who were treated for aortic occlusive disease (9) and abdominal aortic aneurysm (47). Suprarenal cross clamp was used in 52 patients. The renal arteries were controlled with vessel loops in all procedures. Creatinine and glomerular filtration rates (GFR) were measured pre-, post- and long-term after surgery.
RESULTS: Median procedure duration was 157 (61-375) minutes. Median cross clamp time was 16 (10-72) minutes. Median ICU and hospital length of stays were 2 (1-11) days and 7 (4-58) days respectively. There were no deaths. Complications, none of which were directly related to renal vein ligation, are listed in table 1. Hematuria seen in 2 patients was a result of traumatic insertion of a foley catheter.
Median preop and discharge creatinine levels were 1.0mg/dl (0.4-2.1mg/dl) and 1.1mg/dl (0.7-2.4mg/dl) respectively. Median change in creatinine was 0.1mg/dl and only increased in 14 patients (maximum increase 0.9mg/dl). Median preop and discharge GFR was 61ml/min (28-131ml/min) and 66ml/min (32-38ml/min) respectively. Creatinine and GFR in the 2 patients with a creatinine of > 2.0mg/dl remained unchanged postop. Only two patients with a creatinine of <2.0mg/dl had a postop creatinine >2.0mg/dl and both returned to normal by day 3 postop. Thirty two patients have been followed for more than a year (median 34.5 months, max. 144 months) and creatinine has remained stable in all but two. These 2 patients, both with a preop creatinine of 1.5mg/dl, subsequently developed creatinine levels of 2.1mg/dl and 2.4mg/dl but maintained baseline creatinine levels for 25 and 34 months respectively before demonstrating these elevated levels. Hematuria was never recorded after discharge.
CONCLUSIONS: Restoration of left renal vein continuity after surgical division may be unnecessary since renal compromise and lasting hematuria was not encountered in this long-term analysis.