Objective: To analyze the prevalence and incidence of clinical symptoms of retroaortic left renal vein (RLRV) diagnosed incidentally over 10 years by computed tomography (CT). Patients and Methods: 7,929 consecutive patients (out- and inpatients) were studied with multidetector CT from January 2000 to April 2011. We retrospectively reviewed RLRV patients' medical records and analyzed their clinical characteristics. Results: A total of 61 out of 7,929 patients had a RLRV, therefore the prevalence was 0.77%. Only 4 of 61 (6.6%) RLRV patients diagnosed by CT scan were clinically symptomatic. RLRV was associated with flank pain and microhematuria in one patient (1.6%), in another one with microhematuria only and in one with ureteropelvic junction obstruction. Furthermore, one patient suffered from arterial hypertension associated with a RLRV. Conclusions: RLRV is a rare finding, and only a small minority of RLRVs causes symptoms.

Keywords:
Prevalence, Radiology, Retroaortic left renal vein, Surgery, Symptoms
1.
Lee SE, Park DS, Chung SY, Lee YT: Retroaortic renal vein. Korean J Urol 2002;43:84-86.
2.
Gibo M, Onitsuka H: Retroaortic left renal vein with renal vein hypertension causing hematuria. Clin Imaging 1998;22:422-424.
3.
Hohenfellner M, Steinbach F, Schultz-Lampel D, Schantzen W, Walter K, Cramer BM, Thüroff JW, Hohenfellner R: The nutcracker syndrome: new aspects of pathophysiology, diagnosis and treatment. J Urol 1991;146:685-688.
4.
Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D: Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg 2006;20:120-129.
5.
Hosotani Y, Kiyomoto H, Fujioka H, Takahashi X, Kohno M: The nutcracker phenomenon accompanied by renin-dependent hypertension. Am J Med 2003;114:617-618.
6.
Mazarakis A, Almpanis G, Tragotsalou N, Karnabatidis D, Fourtounas C: Is hypertension a manifestation of the nutcracker phenomenon/syndrome? Case report and brief review of the literature. Hippokratia 2012;16:187-189.
7.
Mendizábal S, Román E, Serrano A, Berbel O, Simón J: Left renal vein hypertension syndrome. Nefrologia 2005;25:141-146.
8.
Thomas TV: Surgical implications of retroaortic left renal vein. Arch Surg 1970;100:738-740.
9.
Kurklinsky AK, Rooke TW: Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010;85:552-559.
10.
Hanna HE, Santella RN, Zawada ET Jr, Masterson TE: Nutcracker syndrome: an underdiagnosed cause for hematuria? S D J Med 1997;50:429-436.
11.
Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH: Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 2000;20:639-652.
12.
Mathews R, Smith PA, Fishman EK, Marshall FF: Anomalies of the inferior vena cava and renal veins: embryologic and surgical considerations. Urology 1999;53:873-880.
13.
Cuéllar i Calàbria H, Quiroga Gómez S, Sebastia Cerquedà C, Boyé de la Presa R, Miranda A, Alvarez-Castells A: Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance. Eur Radiol 2005;15:1745-1751.
14.
Karaman B, Koplay M, Ozturk E, Basekim CC, Ogul H, Mutlu H, Kizilkaya E, Kantarci M: Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. Acta Radiol 2007;48:355-360.
15.
Mayo J, Gray R, St Louis E, Grosman H, McLoughlin M, Wise D: Anomalies of the inferior vena cava. AJR Am J Roentgenol 1983;140:339-345.
16.
Royal SA, Callen PW: CT evaluation of anomalies of the inferior vena cava and left renal vein. AJR Am J Roentgenol 1979;132:759-763.
17.
Shindo S, Kubota K, Kojima A, Iyori K, Ishimoto T, Kobayashi M, Kamiya K, Tada Y: Anomalies of inferior vena cava and left renal vein: risks in aortic surgery. Ann Vasc Surg 2000;14:393-396.
18.
Reed MD, Friedmann AC, Nealy P: Anomalies of the left renal vein: analysis of 433 CT scans. J Comput Assist Tomogr 1982;6:1124-1126.
19.
Trigaux JP, Vandroogenbroek S, De Wispelaere JF, Lacrosse M, Jamart J: Congenital anomalies of the inferior vena cava and left renal vein: evaluation with spiral CT. J Vasc Interv Radiol 1998;9:339-345.
20.
Arslan H, Etlik O, Ceylan K, Temizoz O, Harman M, Kavan M: Incidence of retro-aortic left renal vein and its relationship with varicocele. Eur Radiol 2005;15:1717-1720.
21.
Satyapal KS, Kalideen JM, Haffejee AA, Singh B, Robbs JV: Left renal vein variations. Surg Radiol Anat 1999;21:77-81.
22.
Hoeltl W, Hruby W, Aharinejad S: Renal vein anatomy and its implications for retroperitoneal surgery. J Urol 1990;143:1108-1114.
23.
Nam JK, Park SW, Lee SD, Chung MK: The clinical significance of a retroaortic left renal vein. Korean J Urol 2010;51:276-280.
24.
Karkos CD, Bruce IA, Thomson GJ, Lambert ME: Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg 2001;15:703-708.
25.
Minniti S, Visenti S, Procacci C: Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 2002;12:2040-2055.
26.
Hayashi M, Kume T, Nihira H: Abnormalities of renal venous system and unexplained renal hematuria. J Urol 1980;124:12-16.
27.
Barnes RW, Fleisher HL, Redman JF, Smith JW, Harshfield DL, Ferris EJ: Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure. J Vasc Surg 1988;8:415-421.
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2015
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