Next Article in Journal
Adherence to Supervised and Unsupervised Exercise Programmes in Ageing Population with Intermittent Claudication: A Randomized Controlled Trial
Previous Article in Journal
Does Timepoint of Surgical Procedure Affect the Outcome in Simultaneous Pancreas–Kidney Transplantation? A Retrospective Single-Center Analysis over 20 Years
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence

by
Juan Jose Valenzuela Fuenzalida
1,2,
Karla Vera-Tapia
1,
Camila Urzúa-Márquez
1,
Javiera Yáñez-Castillo
1,
Martín Trujillo-Riveros
1,
Zmilovan Koscina
1,
Mathias Orellana-Donoso
1,3,
Pablo Nova-Baeza
1,
Alejandra Suazo-Santibañez
4,
Juan Sanchis-Gimeno
5,
Alejandro Bruna-Mejias
6 and
Héctor Gutiérrez Espinoza
7,*
1
Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
2
Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile
3
Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
4
Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago 8370040, Chile
5
GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain
6
Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile
7
One Health Research Group, Universidad de Las Américas, Quito 170124, Ecuador
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(13), 3689; https://doi.org/10.3390/jcm13133689
Submission received: 21 April 2024 / Revised: 1 June 2024 / Accepted: 14 June 2024 / Published: 25 June 2024
(This article belongs to the Section Nephrology & Urology)

Abstract

:
Background: Variations in renal veins are quite common, and most people do not experience issues due to them. However, these variations are important for healthcare professionals, especially in surgical procedures and imaging studies, as precise knowledge of vascular anatomy is essential to avoid complications during medical interventions. The purpose of this study was to expose the frequency of anatomical variations in the renal vein (RV) and detail their relationship with the retroperitoneal and renal regions. Methods: A systematic search was conducted in the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception until January 2024. Two authors independently carried out the search, study selection, and data extraction and assessed methodological quality using a quality assurance tool for anatomical studies (AQUA). Ultimately, consolidated prevalence was estimated using a random effects model. Results: In total, 91 studies meeting the eligibility criteria were identified. This study included 91 investigations with a total of 46,664 subjects; the meta-analysis encompassed 64 studies. The overall prevalence of multiple renal veins was 5%, with a confidence interval (CI) of 4% to 5%. The prevalence of the renal vein trajectory was 5%, with a CI of 4% to 5%. The prevalence of renal vein branching was 3%, with a CI of 0% to 6%. Lastly, the prevalence of unusual renal vein origin was 2%, with a CI of 1% to 4%. Conclusions: The analysis of these variants is crucial for both surgical clinical management and the treatment of patients with renal transplant and hemodialysis.

1. Introduction

In their usual route, the renal veins (RVs) form in the renal hilum. Along this route, the right renal vein (RRV) receives tributaries, while the left renal vein (LRV) receives the left adrenal vein and the left gonadal vein, ending its journey in the inferior vena cava (IVC) at the level of the L1 vertebra. However, they do not present this way in all individuals, since variants may arise in embryonic development [1,2]. Particularly, when studying RV anatomy, any greater complexity in the RV, due to its relationship with the abdominal aorta (AA) and the superior mesenteric artery (SMA), has its beginning in the embryonic development of these vessels. If anomalies occur in the embryogenesis of this vein, it can surround the AA or the discourse posterior to it. These phenomena are known as the circumaortic renal vein or retroaortic renal vein, respectively. Another important RV variation involves supernumerary veins, also known as multiple RV; instead of one venous trunk, up to four can be found. These variations are more frequently associated with the RRV. Finally, another variation occurs in the accessory vessels that contribute to the RV, including the posterior tributary vein, which connects the posterior course with the renal pelvis [3,4,5,6].
These RV variations have been widely described in meta-analyses of case studies and cadaveric dissections, although the statistics and analysis of their incidences are hardly discussed in the literature. Several studies highlight the importance of these variations in the clinical context. Although they generally do not present symptoms, associations have been described, such as RV hypertension syndrome, in which renal venous hypertension causes venous flow to be directed retrogradely towards the renal parenchyma, generating ruptures of veins in the collecting system. Another syndrome studied in association with these variations is posterior nutcracker syndrome, which presents with macroscopic hematuria and/or associated proteinuria due to compression of the RV. These syndromes have been associated with both variations of LRV described above. Understanding these variations and their incidences can prevent unfavorable results or poor intraoperative practices. The importance of the different renal patterns in renal transplantation and radical nephrectomy cannot be underestimated. Knowledge of the architecture of the renal vessels and a study beforehand to clarify the presence of these variations can be essential to the success of these procedures, especially with the great radiological advances in recent years [7,8,9].
The objective of this review was to know the characteristics and prevalence of the anatomical variants of RV and their relationship with renal pathologies and the importance of knowledge of this anatomical variant in surgeries.

2. Methodology

2.1. Protocol and Registration

To carry out this meta-analysis, we were guided by the Prisma statement. The registration number in the Systematic Reviews Registry (PROSPERO) is CRD42022224066.

2.2. Electronic Search

In order to have the best studies that fit our research question, we searched the following databases during the months of October and November: MEDLINE (via PubMed), Google Scholar, Web of Science (WOS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and the Caribbean Literature in Health Sciences (LILACS), and Scopus from its inception until November 2023. Our search strategy included a combination of the following terms: “renal vein” (Mesh), “renal failure” (not Mesh), “renal vein variations” (not Mesh), “vascularization kidney” (not Mesh), “anatomical variation” (not Mesh), “kidney surgery” (Mesh), and “kidney transplant” (Mesh), using the Boolean connectors AND, OR, and NOT.

2.3. Eligibility Criteria

As eligibility criteria, the studies that were included considered the presence of RV variants and their association with some clinical conditions. They were considered eligible for inclusion if the following criteria were met: (1) sample: dissections or images with the presence of the RV variation; (2) results: prevalence of subjects who presented RV variants and their correlation with pathologies of the retroperitoneal region; (3) studies: this systematic review included research articles, retrospective and prospective observational types, published in English in peer-reviewed journals, and indexed in the reviewed databases.
As exclusion criteria we used the following to eliminate from our selection: (1) sample: studies carried out in animals; (2) studies that analyzed variants of the venous system outside the renal region or its drainage area or tract; (3) letters to the editor or comments.

2.4. Study Selection

In order to make a thorough selection of the studies, we three authors analyzed the material independently. In the first instance, two authors (KV and MT) examined the titles and abstracts of the references recovered from the database searches. For the selected studies, the full text of the references that any of the authors considered potentially relevant was obtained. A third reviewer (PN) was involved if a consensus could not be reached. For this purpose, we also performed the agreement test between authors, the kappa test, to analyze reliability and the risk of bias between observers, which in this case gave 0.70, which is interpreted as a good agreement.

2.5. Data Collection Process

Two authors (MO and KV) independently extracted data on the outcomes of each study. The following data were extracted from the included studies: (a) authors and year of publication, (b) country, (c) type of study and number of participants, (d) sample characteristics and prevalence, (e) reported statistical values, (f) region geography of the study, (g) sex of the sample, and (h) laterality of the presence of the variant (right, left, and bilateral).

2.6. Assessment of the Methodological Quality of the Included Studies

To evaluate the bias of the included studies, we used the verification table for anatomical studies (AQUA) proposed by the International Working Group on Evidence-Based Anatomy (IEBA) [10]. Two reviewers (JJV and JM) independently analyzed the 5 domains proposed by the AQUA tool, then reached a consensus and constructed the table and the bias graph.

2.7. Publication Bias

Through JAMOVI, we made funnel plots. For publication bias, we have the funnel plot graph, where theoretically the data that most affect this criterion are the statistical significance of the primary article and its sample; this graph crosses the sample measurement against the exposure association or confidence interval transformed into standard error against the sample size.

2.8. Statistical Methods

For the statistical analysis, we used the JAMOVI technological tool Version 4.0 2022 (R Core Team, 2021) [11]. Where we included the data in a binary way and continuously to obtain the proportion of the data which we expressed in prevalence, the statistical model used was the DerSimonian–Laird with a Freeman–Tukey double-arcsine transformation to combine the summarized data. Additionally, a random effects model was used because the VD prevalence data were very heterogeneous. The degree of heterogeneity among the included studies was assessed using the chi2 test and the heterogeneity statistic (I2). Finally, with the JAMOVI tool, we analyzed a funnel plot graph where the magnitude of the measured effect is represented, which is graphed in a funnel plot [10].

3. Results

3.1. Included Articles

The researchers identified a total of 1456 articles in various databases that met the established criteria and search terms. Titles and/or abstracts of the articles in the consulted databases were filtered, primarily using duplicate elimination as the initial criterion. Subsequently, 180 full-text articles were analyzed to determine their eligibility in this meta-analysis and systematic review. A total of 148 studies were excluded due to discrepancies in primary and secondary outcomes concerning this review and not meeting the criteria for corresponding data extraction. As a result, 90 articles (n = 46,664) were included for analysis, encompassing patients, images, and cadavers (Figure 1).

3.2. Characteristics of the Studies and the Study Population

The samples analyzed in the reviewed studies came from all continents except Oceania. In Europe, 36 studies were conducted, representing 40% of the total. The cumulative number of patients in these studies was 33,790, consolidating 72.41% of the reviewed samples. A total of 18 studies (20%) were carried out in Asia, with a total of 3368 patients, representing 7.22% of the analyzed samples. In North America, 21 studies were conducted (23.3%), with a cumulative number of 7048 patients, representing 15.1% of the samples. South America had nine studies (10%) with a total of 969 patients, accounting for 2.07% of the samples in our analysis (Table 1 and Figure 2). Finally, in Africa, six studies were conducted (6.6%), with a cumulative total of 1489 patients, representing 3.19% of the sample size in our analysis.
Regarding the focus of the studies, 42 analyzed the renal vein bilaterally, while 4 focused only on the right side and 44 only on the left side. In addition, of the patients included in the reviewed studies, 31.91% were male, 25.63% were female, and 41.19% chose not to specify their gender (Table 1).

3.3. Description of Variants

Among the RV variants found in the literature that we analyzed in this prevalence study, variations were found at the level of origin of the RV and the trajectory of the RV; additionally, some cases included multiple RV and variations in the ramifications of the RV. For the variants in the origin of the RV, a variant of origin of LRV was considered any situation in which the RV, both unilaterally and bilaterally, arose from a level lower than L2-L3 from the IVC; the RV arose from a different site to the IVC; the drainage occurred at the level of the lateral aspect of the IVC; or a late venous confluence was present where both the origin of the RV and its path towards the renal hilum were affected. For the RV course variants, the normal course of the RV was considered in which the RV crossed the anterior part of the AA to drain into the IVC. The variants observed in the literature with the highest prevalence were the retroaortic and circumaortic paths of RV (Figure 3 and Figure 4). A retroaortic RV path is any path in which the RV crosses the posterior part of the AA, finally draining into the IVC; a circumaortic course is one in which the RV forms a circle around the AA and drains into the IVC. For the multiple RV variant, all RVs with a single vascular trunk were considered normal. The ones with double, triple, and quadruple trunk of the RV were considered multiple RV variants, either unilaterally or bilaterally. Finally, all cases in which the RV had one or more accessory branches and the latter ending up draining into the IVC were considered the RV branching variant (Figure 5).

3.4. Prevalence

To calculate the prevalence of RV variants in the studies included in this review (Table 2), four proportion forest plots were made. For the multiple RV variant, a forest diagram was made with 22 studies (Figure 6) [15,20,21,28,30,31,32,33,49,50,53,54,57,72,77,80,82,83,86,90,94,97]. For this first sample, the funnel plot graph showed an important asymmetry which presented a p value of 0.412, which is directly related to this asymmetry (Figure 7). The diagram showed that the prevalence of multiple RV was 7%, with a confidence interval of 6% to 9%. For the RV course variant, 64 studies were included (Figure 8) [3,7,15,18,21,22,23,24,25,26,27,29,31,33,34,37,38,39,41,42,43,44,45,46,49,50,53,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,72,73,74,75,76,78,79,81,82,84,85,86,87,88,89,90,91,92,94,95,97,98]. For this second sample, the funnel plot graph showed an important asymmetry which presented a p value of 0.560, which is directly related to this asymmetry (Figure 9, and the prevalence of the RV course variant was 5%, with a confidence interval of 4% to 5%. The RV branching variant forest plot included four (Figure 10) [43,66,80,90]. For this third sample, the funnel plot graph showed an important asymmetry which presents a p value of 0.162, which is directly related to this asymmetry (Figure 11). The prevalence of RV ramifications was 3%, with a confidence interval of 0% to 6%. Finally, for the unusual origin of RV, three studies were analyzed, and the prevalence was 2%, with a confidence interval of 1% to 4% (Figure 12) [53,60,73]. For this fourth sample, the funnel plot graph showed an important asymmetry which presented a p value of 0.382, which is directly related to this asymmetry (Figure 13). The pooled prevalence of studies independently in prospective studies (49 studies) and retrospective studies (15 studies) was calculated. The prevalence in prospective studies was p = 0.413 (95% CI 0.323–0.504), and in retrospective studies, it was p = 0.278 (95% CI 0.03–0.526). It is noted that the difference was not significant. Additionally, it is important to highlight that heterogeneity was very high in both groups (I2 91.63% in prospective studies and 92.62% in retrospective studies). Furthermore, it is worth noting that in both groups, there was publication bias based on the asymmetry of the funnel plot.

3.5. Risk of Bias of Included Articles

A total of 79 articles were evaluated with the AQUA checklist to analyze the risk of bias in five domains (Figure 10). For the first domain, which covers the description of the objectives and characteristics of the study, all studies presented a low risk of bias. The second domain is the correct reporting of the study design. A total of 76 studies presented a low risk of bias in this domain, and 3 presented a high risk since they did not clearly report the design of their studies [18,75,94]. For the third domain, which analyzes the study’s methodological characteristics, 77 studies presented a low risk of bias, while 2 presented a high risk since their methodology was unclear [32,70]. The fourth domain is the correct description of anatomy. A total of 78 studies presented a low risk of bias in this domain, while only 1 study presented a higher risk since it did not include an anatomical description of the variant but instead merely named it [88]. In the final domain, which involves reporting results, 72 studies presented a low risk of bias, 2 presented their results unclearly, and 5 studies presented a high risk of bias since their results were presented diffusely in tables or in discussion sections [18,57,75,88,94] (Figure 14).
For the analysis of studies with case report methodology, the JBI tool was used to assess the risk of bias. A total of 12 studies were analyzed within the eight domains of this bias tool [13,14,16,19,35,40,48,52,55,71,93,99]. The majority presented a low risk of bias in domains 1 to 6. However, in domain 7, which focuses on adverse events (harms) or unanticipated events, seven studies presented a high risk of bias [13,14,16,19,52,71,99]. Domain 8 analyzes whether the case report provides takeaway lessons. Seven studies presented a high risk of bias since they did not comply with what was proposed in this domain (Table 3 and Table 4) [13,14,16,40,52,55,71].

3.6. Clinical Considerations

Among the 90 studies analyzed in this review, 59 demonstrated some clinical correlation to the various anatomical variations of RV. For the most part, these variations are clinically silent [29,33,39,47,67,77,83]; however, when they produce symptoms, we can observe syndromes such as the “nutcracker syndrome” [2,22,24,29,41,65,100], which corresponds to a compression of the LRV in its retroaortic variation caused by the SMA (superior mesenteric artery) and the AA (abdominal aorta). This syndrome is rare and classically presents with proteinuria and hematuria; therefore, it is diagnosed through laboratory tests, such as urinalysis [25,29,31,34,39,42,58,65,83]. It can also have significant complications, such as dilation of the gonadal vein, generating varicocele in men [2,22,23,25,34,42,61,65], and pelvic congestion syndrome in women [29,39,58,83]. Varicocele is the dilation of the veins within the scrotum. It is usually asymptomatic but can cause a decrease in sperm production and quality, which may eventually lead to infertility. On the other hand, pelvic congestion syndrome in women is the accumulation of venous blood in the pelvis. This is a common cause of chronic pelvic pain in women and causes the appearance of varicose veins in the vulva, vagina, or thigh [34].
Preoperative knowledge of each of these anatomical variations is of utmost importance, since they can influence the viability of the procedure [77]. Understanding them helps facilitate the procedure’s safe performance [29,45,54] and reduce complications during and after retroperitoneal interventions, which include kidney transplantation, AA aneurysm surgery, gonadal surgery, lymphadenectomy, and nephrectomy [6,23,24,35,46,48,49,65,70,72,78,79,95]. The most prominent compilation is hemorrhage [28,32,34,43,74,80,89]. On the other hand, ignorance of these variables can compromise or complicate surgery [30,31,101] and even cause injury to some of these vessels [26,33,83,88]. Various types of imaging, such as computed axial tomography (CAT) angiography [33,63,78], abdominal computed tomography (CT) with contrast [44,45,46,52,88], and multidetector computed tomography (MDCT) [24,31,50,57,63,64,93,102], have been recommended to study the different anatomical variations of RV.

4. Discussion

This systematic review and meta-analysis aimed to report the anatomo-clinical characteristics and prevalence of RV variants and their association with pathologies of the kidney or surrounding structures. The main finding of our review was the correlation between the prevalence of RV variants and different surgeries of the renal region, as well as hemodialysis.
As we observed in this review, variants of RV can be of more than one type, including variants in the origin of RV or journey and entry to the IVC; increased numbers of RV, known as multiple RV, can also occur. Yi et al. (2012) [35] also analyzed RV variants. Only 27 studies were included, in contrast to the present study, which included 90 studies overall and 63 for the meta-analysis of RV journey prevalence. Furthermore, we believe that the prevalence of RV variants is overestimated in their review. They present very high values and define them as common variabilities. Our detailed study shows low prevalence in our different forest plots, suggesting that their data may have been calculated with values from primary studies that only looked for the variant.
The last manuscript associated with the variants of the RV was published in 2019, so this review updates the topic of RV over the past 5 years. In relation to the latter, we make a detailed review of the anatomy of the different variants of the renal vein, adding that we make a clinical correlation, which is why, apart from the years of the last publication on the RV variants, we approached the variant through translational anatomy and providing strong support between the anatomy and the clinical correlations. Hostiuc et al.’s (2019) [103] review does not detail the anatomical characteristics of each RV; in our study, we detailed the variants by subgroup. Their review included 105 studies with an accurate meta-analysis; it differs from our study in that they did not detail the clinical correlations of these. Furthermore, we provided a detailed anatomical description of each variant to provide clinical support for the study of translational anatomy of RV.
There was no indication in the included studies that RV variants had any type of relationship to the sex of the subjects. Similarly, there was no type of indication that RV variants are associated with any specific ethnicity or race; however, to further support this hypothesis, we suggest that more interracial studies should be carried out. With respect to laterality, there was also no type of indication in the studies that variants were associated with the left side or with the right side in specific ethnicities. Finally, age was a value that we did not consider in our study since variants are congenital and thus unrelated to the age of the subjects.
We grouped the variants as RV course variant, multiple RV variant, unusual origin of RV, and variant of RV ramifications. Studies that reported the RV course variant were more commonly found; this is associated with a retroaortic and anteroaortic passage, generating a kind of circumduction on the RV. We did not consider primary studies that showed low prevalences, because if we included all the studies, the results could have been overestimated. We believe that when the prevalence of the variants was high, it is because the sample was intentional and not random; this alters the data from the prevalence meta-analysis, so we decided to not include these results. We generated four prevalence forest plots and found a prevalence of 8% for multiple RV, a prevalence of 5% for course variants, a prevalence of 5% for RV ramifications variants, and a prevalence of 2% for unusual origin of the RV. Finally, we analyzed the publication bias through a funnel plot for each of the prevalence measurements, and we detected a high level of publication bias among some studies, which is why the data must be interpreted with caution.
The heterogeneity of the studies was between 80 and 97%, which is high and could over- or underestimate the reported results. Thus, they should be taken with caution, and we recommend further studies. The AQUA tool was used to assess the bias of the included studies. The results show a low risk of bias in the five domains in all the included studies; therefore the data were included with greater security for the analysis. The case reports presented greater bias in the analysis of results, so we only considered those that presented variants that were underrepresented in the literature or reported some important clinical correlation that supported their inclusion. Finally, while the clinical considerations reported in this study were varied, we focused above all on the intrasurgical care of the abdominal region and the retroperitoneal region, since these variants are often silent and their description or discovery is associated with routine examinations or pathologies of surrounding structures. The only syndrome reported with symptomatology is “nutcracker syndrome”, which typically presents signs such as hematuria and must be diagnosed with laboratory tests. This syndrome is very rare in the literature; unfortunately, no article presented a clear prevalence, but we estimate due to the amount of information on the subject that it is less than 1%.
In kidney transplantation, dilemmas can arise due to the positioning of the RV. In the presence of these variants, the veins have acquired an arrangement in the abdominal region, occupying uncommon regions. Patients are often asymptomatic, so many surgeons choose to maintain the arrangements of these variants in transplant surgery [104,105,106]. Finally, an equally important clinical correlation is the presence of RV variation before hemodialysis, which is associated with greater complexity in performing the catheterization, because the arrangement of the RV and the surrounding structures may be different. It has also been reported that this could increase the probability of clots or thrombi; a thorough analysis of the region can prevent these complex conditions.

5. Limitations

This review was limited by the publication and authorship bias of the included studies. First, studies with different results that were in the nonindexed literature in the selected databases may have been excluded. Second, there could be limitations in the sensitivity and specificity of the searches. Finally, the authors personally selected articles. All of this increases the probability of excluding potential cases from countries outside of Asia and North America that are not being reported in the scientific community.

6. Conclusions

The presence of RV variants has been widely described in the literature. Our results show that the variants of the renal vein can be multiple and that mainly, the lack of knowledge of these could cause iatrogenic injuries during surgeries of structures surrounding the kidney. Regarding patients who receive a kidney transplant and present the RV variant, the surgeon must know how this variant could make work more difficult with these patients; however, prior knowledge could help the surgery to be planned with all these considerations, and these changes could improve the probability of surgical success in these patients. We also believe that more studies that explain how this variant behaves and the symptoms associated with the variant could be necessary.

Author Contributions

Conceptualization, M.O.-D., A.B.-M., K.V.-T. and J.J.V.F.; methodology, M.T.-R., Z.K. and P.N.-B.; software, J.J.V.F. and H.G.E.; validation, J.J.V.F., J.S.-G. and M.O.-D.; formal analysis, C.U.-M. and J.Y-C.; investigation, J.J.V.F., H.G.E. and J.Y.-C.; resources, J.J.V.F.; data curation, K.V.-T., A.B.-M. and Z.K.; writing—original draft preparation, P.N.-B.; writing—review and editing, J.J.V.F.; visualization, M.O.-D. and A.S.-S.; supervision, A.S.-S.; project administration J.J.V.F. and A.B.-M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Itoh, M.; Moriyama, H.; Tokunaga, Y.; Miyamoto, K.; Nagata, W.; Satriotomo, I.; Shimada, K.; Takeuchi, Y. Embryological consideration of drainage of the left testicular vein into the ipsilateral renal vein: Analysis of cases of a double inferior vena cava. Int. J. Androl. 2001, 24, 142–152. [Google Scholar] [CrossRef] [PubMed]
  2. Bowdino, C.S.; Owens, J.; Shaw, P.M. Anatomy, Abdomen and Pelvis, Renal Veins. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2023. [Google Scholar]
  3. Hoeltl, W.; Hruby, W.; Aharinejad, S. Renal vein anatomy and its implications for retroperitoneal surgery. J. Urol. 1990, 143, 1108–1114. [Google Scholar] [CrossRef] [PubMed]
  4. Iimura, A.; Oguchi, T.; Matsuo, M.; Hayashi, S.; Moriyama, H.; Itoh, M. Anatomical study of the coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein with a review of the literature. Okajimas Folia Anat. Jpn. 2014, 91, 73–82. [Google Scholar] [CrossRef] [PubMed]
  5. Famurewa, O.C.; Asaleye, C.M.; Ibitoye, B.O.; Ayoola, O.O.; Aderibigbe, A.S.; Badmus, T.A. Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys. Niger. J. Clin. Pract. 2018, 21, 840–846. [Google Scholar] [CrossRef] [PubMed]
  6. Shaheen, R.; Jamil, M.N.; Farooq, U. Anatomic Patterns of Right Renal Vein. J. Ayub Med. Coll. Abbottabad. 2019, 31, 55–59. [Google Scholar] [PubMed]
  7. Janschek, E.C.; Rothe, A.U.; Hölzenbein, T.J.; Langer, F.; Brugger, P.C.; Pokorny, H.; Domenig, C.M.; Rasoul-Rockenschaub, S.; Mühlbacher, F. Anatomic basis of right renal vein extension for cadaveric kidney transplantation. Urology 2004, 63, 660–664. [Google Scholar] [CrossRef] [PubMed]
  8. Pinto, M.S.; Mitre, A.I.; Sheepmaker, R.; Nahas, W.C.; Dénes, F.T.; Coelho, R.F.; David Neto, E.; Srougi, M. Evaluation of cadaveric renal vein lengths and their extension loss with three types of ligature and section. J. Endourol. 2009, 23, 995–1000. [Google Scholar] [CrossRef]
  9. Vu, L.N.; Nghia, N.Q.; Thanh, D.T.; Giang, T.B.; Nga, V.T.; Bui, L.M.; Chu, D.T. Laparoscopic living donor right nephrectomy: Assessment of outcome and association of BMI to length of right renal vein. Actas Urol. Esp. (Engl. Ed.) 2019, 43, 536–542. [Google Scholar] [CrossRef] [PubMed]
  10. Henry, B.M.; Tomaszewski, K.A.; Walocha, J.A. Methods of Evidence-Based Anatomy: A guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann. Anat. 2016, 205, 16–21. [Google Scholar] [CrossRef]
  11. R Core Team. R: A Language and Environment for Statistical Computing. (2021) (Version 4.0) [Computer Software]. R Packages Retrieved from MRAN Snapshot 2021-04-01. Available online: https://cran.r-project.org (accessed on 20 March 2024).
  12. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Rev. Esp. Cardiol. 2021, 74, 790–799, Correction in Rev. Esp. Cardiol. (Engl. Ed.) 2022, 75, 192. [Google Scholar]
  13. Pedrão, I.; Valeri, M.T.A.; Gonsalves, D.G.; Afonso, N.M.; Signori, A.G.; Rissi, R. Anomalous drainage of the right gonadal vein. Anat. Sci. Int. 2023, 98, 143–146. [Google Scholar] [CrossRef] [PubMed]
  14. Silva, T.A.; Buonfiglio, V.B. Triple Retroaortic Renal Vein with Tumor Thrombus. Urology 2021, 154, e17–e18. [Google Scholar] [CrossRef] [PubMed]
  15. Pradeep, R.; Amatya, I.; Kayastha, P.; Paudel, S.; Suwal, S.; Ghimire, R.K. Normal Anatomy and Variants of Renal Vasculature with Multidetector Computed Tomography in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J. Nepal Med. Assoc. 2020, 58, 911–914. [Google Scholar] [CrossRef]
  16. Salimy, M.S.; Luiselli, G.A.; Yuen, M.; Healy, R.C.; Shah, S.G.; Giannaris, E.L.; Das, M.; Wink, A.E. A case of solitary kidney with duplex collecting systems and renal vascular variants in an adult male cadaver. Folia Morphol. 2021, 80, 722–725. [Google Scholar] [CrossRef]
  17. Fontana, F.; Coppola, A.; Ossola, C.; Beneventi, A.; Macchi, E.; Fugazzola, C. Hypoplasia of right renal vein with aberrant drainage into ipsilateral spermatic vein: Case report. Radiol. Case Rep. 2018, 14, 156–159. [Google Scholar] [CrossRef]
  18. Tatarano, S.; Enokida, H.; Yamada, Y.; Nishimura, H.; Yoshino, H.; Ishihara, T.; Yonemori, M.; Eura, R.; Sakaguchi, T.; Nakagawa, M. Anatomical Variations of the Left Renal Vein During Laparoscopic Donor Nephrectomy. Transplant. Proc. 2019, 51, 1311–1313. [Google Scholar] [CrossRef] [PubMed]
  19. Dunnwald, M.; Pizzimenti, M.A. A Case Study of Malrotated Kidneys with Asymmetric Multiple Renal Arteries, Variant Venous Drainage, and Unilateral Ureteral Duplication. Case Rep. Vasc. Med. 2019, 2019, 1893137. [Google Scholar] [CrossRef]
  20. Hassan, S.S.; El-Shaarawy, E.A.; Johnson, J.C.; Youakim, M.F.; Ettarh, R. Incidence of variations in human cadaveric renal vessels. Folia Morphol. 2017, 76, 394–407. [Google Scholar] [CrossRef]
  21. Nambur, B. A study of renal veins. Int. J. Anat. Res. 2017, 5, 4463–4468. [Google Scholar] [CrossRef]
  22. Ayaz, S.; Ayaz, Ü.Y. Detection of retroaortic left renal vein and circumaortic left renal vein by PET/CT images to avoid misdiagnosis and support possible surgical procedures. Hell. J. Nucl. Med. 2016, 19, 135–139. [Google Scholar]
  23. Çınar, C.; Türkvatan, A. Prevalence of renal vascular variations: Evaluation with MDCT angiography. Diagn. Interv. Imaging 2016, 97, 891–897. [Google Scholar] [CrossRef] [PubMed]
  24. Duran, J.T.C.; Ferreira, H. Anatomical Study of Retro-Aortic Left Renal Vein. J. Chem. Pharm. Res. 2016, 8, 1011–1018. [Google Scholar]
  25. Kumaresan, M.; Sankaran, P.K.; Gunapriya, R.; Karthikeyan, G.; Priyadarshini, A. Morphometric study of renal vein and its variations using CT. Indian J. Med. Res. Pharm. Sci. 2016, 3, 41–49. [Google Scholar] [CrossRef]
  26. Pandya, V.K.; Patel, A.S.; Sutariya, H.C.; Gandhi, S.P. Evaluation of renal vascular anatomy in live renal donors: Role of multi detector computed tomography. Urol. Ann. 2016, 8, 270–276. [Google Scholar] [CrossRef] [PubMed]
  27. Staśkiewicz, G.; Jajko, K.; Torres, K.; Czekajska-Chehab, E.; Maciejewski, R.; Drop, A. Supernumerary renal vessels: Analysis of frequency and configuration in 996 computed tomography studies. Folia Morphol. 2016, 75, 245–250. [Google Scholar] [CrossRef] [PubMed]
  28. Bouzouita, A.; Kerkeni, W.; Bouchiba, N.; Allouche, M.; Mighri, M.M.; Hamdoun, M.; Chebil, M. Anatomical variations of renal venous vascularisation. A study of 71 three-dimensional kidney endocasts. Tunis. Med. 2015, 93, 16–20. [Google Scholar] [PubMed]
  29. Heidler, S.; Hruby, S.; Schwarz, S.; Sellner-Zwieauer, Y.; Hoeltl, W.; Albrecht, W. Prevalence and incidence of clinical symptoms of the retroaortic left renal vein. Urol. Int. 2015, 94, 173–176. [Google Scholar] [CrossRef]
  30. Reginelli, A.; Somma, F.; Izzo, A.; Urraro, F.; D’Andrea, A.; Grassi, R.; Cappabianca, S. Renovascular anatomic variants at CT angiography. Int. Angiol. 2015, 34 (Suppl. 1), 36–42. [Google Scholar]
  31. Resorlu, M.; Sariyildirim, A.; Resorlu, B.; Sancak, E.B.; Uysal, F.; Adam, G.; Akbas, A.; Aylanc, N.; Gulpinar, M.T.; Karatag, O.; et al. Association of congenital left renal vein anomalies and unexplained hematuria: Multidetector computed tomography findings. Urol. Int. 2015, 94, 177–180. [Google Scholar] [CrossRef]
  32. Zhu, J.; Zhang, L.; Yang, Z.; Zhou, H.; Tang, G. Classification of the renal vein variations: A study with multidetector computed tomography. Surg. Radiol. Anat. 2015, 37, 667–675. [Google Scholar] [CrossRef]
  33. Ballesteros, L.E.; Saldarriaga, V.; Ramirez, L.M. Morphologic evaluation of the renal veins: A study with autopsy material from Colombian subjects. Rom. J. Morphol. Embryol. 2014, 55, 77–81. [Google Scholar] [PubMed]
  34. Boyaci, N.; Karakas, E.; Dokumacı, D.S.; Yildiz, S.; Cece, H. Evaluation of left renal vein and inferior vena cava variations through routine abdominal multi-slice computed tomography. Folia Morphol. 2014, 73, 159–163. [Google Scholar] [CrossRef] [PubMed]
  35. Ferreira, A.H. Variaciones anatómicas de vasos renales y testiculares bilaterales. Rev. CES Med. 2014, 28, 273–281. [Google Scholar]
  36. Lavy, M.; Martin, L.; Eouzan, D.; Turco, C.; Heyd, B.; Mantion, G.; Parratte, B.; Tatu, L. An unusual case of Y-shaped right renal vein. Surg. Radiol. Anat. 2015, 37, 101–104. [Google Scholar] [CrossRef]
  37. Rashid, R.J.; Tarzemani, M.K.; Mohtasham, M.A.; Zomorrodi, A.; Kakaei, F.; Jalili, J.; Habibzadeh, A. Diagnostic accuracy of 64-MDCT angiography in the preoperative evaluation of renal vessels and compared with laparotomy findings in living donor kidney. Ren. Fail. 2014, 36, 327–331. [Google Scholar] [CrossRef]
  38. Șahin, C.; Kaçira, O.K.; Tüney, D. The retroaortic left renal vein abnormalities in cross-sectional imaging. Folia Med. (Plovdiv) 2014, 56, 38–42. [Google Scholar] [CrossRef] [PubMed]
  39. Dilli, A.; Ayaz, U.Y.; Kaplanoğlu, H.; Saltas, H.; Hekimoglu, B. Evaluation of the left renal vein variations and inferior vena cava variations by means of helical computed tomography. Clin. Imaging 2013, 37, 530–535. [Google Scholar] [CrossRef]
  40. Eid, N.; Ito, Y.; Otsuki, Y. The left inferior vena cava: A surgically important variant tributary of left renal vein. Surg. Radiol. Anat. 2013, 35, 455–456. [Google Scholar] [CrossRef]
  41. Poyraz, A.K.; Firdolas, F.; Onur, M.R.; Kocakoc, E. Evaluation of left renal vein entrapment using multidetector computed tomography. Acta Radiol. 2013, 54, 144–148. [Google Scholar] [CrossRef]
  42. Tao, X.F.; Zhu, J.Q.; Wu, Y.W.; Tang, G.Y.; Shi, Y.Z.; Zhang, L.; Lin, Y.; Wang, Z.Q. Dual-energy computed tomography angiography for evaluating the renal vascular variants. Chin. Med. J. (Engl.) 2013, 126, 650–654. [Google Scholar] [CrossRef]
  43. Apisarnthanarak, P.; Suvannarerg, V.; Muangsomboon, K.; Taweemonkongsap, T.; Hargrove, N.S. Renal vascular variants in living related renal donors: Evaluation with CT angiography. J. Med. Assoc. Thai. 2012, 95, 941–948. [Google Scholar]
  44. Atalar, M.H.; Kosar, M.I.; Salk, I.; Isleyen, M. Left renal vein abnormalities detected during routine abdominal computed tomography imaging: Clinico-radiological significance. Folia Morphol. 2012, 71, 168–172. [Google Scholar]
  45. Bouali, O.; Labarre, D.; Molinier, F.; Lopez, R.; Benouaich, V.; Lauwers, F.; Moscovici, J. Anatomic variations of the renal vessels: Focus on the precaval right renal artery. Surg. Radiol. Anat. 2012, 34, 441–446. [Google Scholar] [CrossRef]
  46. Dilli, A.; Ayaz, U.Y.; Karabacak, O.R.; Tatar, I.G.; Hekimoglu, B. Study of the left renal variations by means of magnetic resonance imaging. Surg. Radiol. Anat. 2012, 34, 267–270. [Google Scholar] [CrossRef]
  47. Gupta, A.; Gupta, R.; Singal, R. Congenital Variations of Renal Veins: Embryological Background and Clinical Implications. J. Chem. Pharm. Res. 2011, 5, 1140–1143. [Google Scholar]
  48. Yi, S.Q.; Ueno, Y.; Naito, M.; Ozaki, N.; Itoh, M. The three most common variations of the left renal vein: A review and meta-analysis. Surg. Radiol. Anat. 2012, 34, 799–804. [Google Scholar] [CrossRef]
  49. Costa, H.C.; Moreira, R.J.; Fukunaga, P.; Fernandes, R.C.; Boni, R.C.; Matos, A.C. Anatomic variations in vascular and collecting systems of kidneys from deceased donors. Transplant. Proc. 2011, 43, 61–63. [Google Scholar] [CrossRef]
  50. Kulkarni, S.; Emre, S.; Arvelakis, A.; Asch, W.; Bia, M.; Formica, R.; Israel, G. Multidetector CT angiography in living donor renal transplantation: Accuracy and discrepancies in right venous anatomy. Clin. Transplant. 2011, 25, 77–82. [Google Scholar] [CrossRef]
  51. Li, G.; Dong, J.; Lu, J.S.; Zu, Q.; Yang, S.X.; Li, H.Z.; Ma, X.; Zhang, X. Anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy. Int. J. Urol. 2011, 18, 503–509. [Google Scholar] [CrossRef] [PubMed]
  52. Favaro, W.J.; Santos, T.D.; Cagnon, V.H. Venous communication between the right and left kidneys: A rare anatomic variation. Int. J. Morphol. 2009, 27, 117–120. [Google Scholar] [CrossRef]
  53. Turkvatan, A.; Akinci, S.; Yildiz, S.; Olçer, T.; Cumhur, T. Multidetector computed tomography for preoperative evaluation of vascular anatomy in living renal donors. Surg. Radiol. Anat. 2009, 31, 227–235. [Google Scholar] [CrossRef]
  54. Kaneko, N.; Kobayashi, Y.; Okada, Y. Anatomic variations of the renal vessels pertinent to transperitoneal vascular control in the management of trauma. Surgery 2008, 143, 616–622. [Google Scholar] [CrossRef]
  55. Mir, N.S.; Ul Hassan, A.; Rangrez, R.; Hamid, S.; Sabia Tabish, S.A.; Iqbal Suhaila Masarat Rasool, Z. Bilateral Duplication of Renal Vessels: Anatomical, Medical and Surgical perspective. Int. J. Health Sci. (Qassim) 2008, 2, 179–185. [Google Scholar]
  56. Natsis, K.; Tsitouridis, I.; Totlis, T.; Levva, S.; Tsikaras, P.; Skandalakis, P. Proposal for classification of the circumaortic renal collar’s morphology. Am. Surg. 2008, 74, 1190–1194. [Google Scholar] [CrossRef]
  57. Tombul, S.T.; Aki, F.T.; Gunay, M.; Inci, K.; Hazirolan, T.; Karcaaltincaba, M.; Erkan, I.; Bakkaloglu, A.; Yasavul, U.; Bakkaloglu, M. Preoperative evaluation of hilar vessel anatomy with 3-D computerized tomography in living kidney donors. Transplant. Proc. 2008, 40, 47–49. [Google Scholar] [CrossRef]
  58. Yagci, B.; Tavasli, B.; Karabulut, N.; Kiroglu, Y. Clinical significance and renal haemodynamics of incidentally detected retroaortic left renal vein: Assessment with venous Doppler sonography. Br. J. Radiol. 2008, 81, 187–191. [Google Scholar] [CrossRef]
  59. Holt, P.J.; Adshead, J.M.; Filiadis, I.; Christmas, T.J. Retroperitoneal anomalies in men with testicular germ cell tumours. BJU Int. 2007, 99, 344–346. [Google Scholar] [CrossRef]
  60. Karaman, B.; Koplay, M.; Ozturk, E.; Basekim, C.C.; 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. [Google Scholar] [CrossRef]
  61. Karazincir, S.; Balci, A.; Görür, S.; Sumbas, H.; Kiper, A.N. Incidence of the retroaortic left renal vein in patients with varicocele. J. Ultrasound Med. 2007, 26, 601–604. [Google Scholar] [CrossRef] [PubMed]
  62. Koc, Z.; Ulusan, S.; Oguzkurt, L.; Tokmak, N. Venous variants and anomalies on routine abdominal multi-detector row CT. Eur. J. Radiol. 2007, 61, 267–278. [Google Scholar] [CrossRef] [PubMed]
  63. Raman, S.S.; Pojchamarnwiputh, S.; Muangsomboon, K.; Schulam, P.G.; Gritsch, H.A.; Lu, D.S. Surgically relevant normal and variant renal parenchymal and vascular anatomy in preoperative 16-MDCT evaluation of potential laparoscopic renal donors. AJR Am. J. Roentgenol. 2007, 188, 105–114. [Google Scholar] [CrossRef] [PubMed]
  64. Namasivayam, S.; Kalra, M.K.; Waldrop, S.M.; Mittal, P.K.; Small, W.C. Multidetector row CT angiography of living related renal donors: Is there a need for venous phase imaging? Eur. J. Radiol. 2006, 59, 442–452. [Google Scholar] [CrossRef]
  65. 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. [Google Scholar] [CrossRef]
  66. Kawamoto, S.; Lawler, L.P.; Fishman, E.K. Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors. AJR Am. J. Roentgenol. 2005, 184, 539–545. [Google Scholar] [CrossRef] [PubMed]
  67. Klemm, P.; Fröber, R.; Köhler, C.; Schneider, A. Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecol. Oncol. 2005, 96, 278–282. [Google Scholar] [CrossRef] [PubMed]
  68. Lin, C.H.; Steinberg, A.P.; Ramani, A.P.; Abreu, S.C.; Desai, M.M.; Kaouk, J.; Goldfarb, D.A.; Gill, I.S. Laparoscopic live donor nephrectomy in the presence of circumaortic or retroaortic left renal vein. J. Urol. 2004, 171, 44–46. [Google Scholar] [CrossRef] [PubMed]
  69. Yeh, B.M.; Coakley, F.V.; Meng, M.V.; Breiman, R.S.; Stoller, M.L. Precaval right renal arteries: Prevalence and morphologic associations at spiral CT. Radiology 2004, 230, 429–433. [Google Scholar] [CrossRef] [PubMed]
  70. Yeşildağ, A.; Adanir, E.; Köroğlu, M.; Baykal, B.; Oyar, O.; Gülsoy, U.K. Rutin abdomen BT’de sol renal ven anomalilerinin görülme sikliği [Incidence of left renal vein anomalies in routine abdominal CT scans]. Tani. Girisim. Radyol. 2004, 10, 140–143. (In Turkish) [Google Scholar] [PubMed]
  71. Senecail, B.; Bobeuf, J.; Forlodou, P.; Nonent, M. Two rare anomalies of the left renal vein. Surg. Radiol. Anat. 2003, 25, 465–467. [Google Scholar] [CrossRef] [PubMed]
  72. Duques, P.; Rodrigues, J.R.; Silva Neto, F.B.; SNeto, E.M.; Tolêdo, E.S. Estudo anatômico da veia renal izquierda de cadáveres humanos brasileiros. Medicina 2002, 35, 184–191. [Google Scholar] [CrossRef]
  73. Sèbe, P.; Peyromaure, M.; Raynaud, A.; Delmas, V. Anatomical variations in the drainage of the principal adrenal veins: The results of 88 venograms. Surg. Radiol. Anat. 2002, 24, 222–225. [Google Scholar] [CrossRef]
  74. Aljabri, B.; MacDonald, P.S.; Satin, R.; Stein, L.S.; Obrand, D.I.; Steinmetz, O.K. Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Ann. Vasc. Surg. 2001, 15, 615–618. [Google Scholar] [CrossRef]
  75. 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. [Google Scholar] [CrossRef] [PubMed]
  76. Yoshinaga, K.; Kawai, K.; Kodama, K. An anatomical study of the retroaortic left renal vein. Okajimas Folia Anat. Jpn. 2000, 77, 47–52. [Google Scholar] [CrossRef]
  77. Satyapal, K.S.; Kalideen, J.M.; Haffejee, A.A.; Singh, B.; Robbs, J.V. Left renal vein variations. Surg. Radiol. Anat. 1999, 21, 77–81. [Google Scholar] [CrossRef]
  78. Pozniak, M.A.; Balison, D.J.; Lee, F.T., Jr.; Tambeaux, R.H.; Uehling, D.T.; Moon, T.D. CT angiography of potential renal transplant donors. Radiographics 1998, 18, 565–587. [Google Scholar] [CrossRef]
  79. Trigaux, J.P.; Vandroogenbroek, S.; De Wispelaere, J.F.; 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. [Google Scholar] [CrossRef]
  80. Baptista-Silva, J.C.; Veríssimo, M.J.; Castro, M.J.; Câmara, A.L.; Pestana, J.O. Anatomical study of the renal veins observed during 342 living-donor nephrectomies. Sao Paulo Med. J. 1997, 115, 1456–1459. [Google Scholar] [CrossRef]
  81. Hicks, M.E.; Malden, E.S.; Vesely, T.M.; Picus, D.; Darcy, M.D. Prospective anatomic study of the inferior vena cava and renal veins: Comparison of selective renal venography with cavography and relevance in filter placement. J. Vasc. Interv. Radiol. 1995, 6, 721–729. [Google Scholar] [CrossRef] [PubMed]
  82. Kaufman, J.A.; Waltman, A.C.; Rivitz, S.M.; Geller, S.G. Anatomical observations on the renal veins and inferior vena cava at magnetic resonance angiography. Cardiovasc. Interv. Radiol. 1995, 18, 153–157. [Google Scholar] [CrossRef]
  83. Satyapal, K.S. Classification of the drainage patterns of the renal veins. J. Anat. 1995, 186 Pt 2, 329–333. [Google Scholar] [PubMed]
  84. Benedetti-Panici, P.; Maneschi, F.; Scambia, G.; Greggi, S.; Mancuso, S. Anatomic abnormalities of the retroperitoneum encountered during aortic and pelvic lymphadenectomy. Am. J. Obstet. Gynecol. 1994, 170 Pt 1, 111–116. [Google Scholar] [CrossRef]
  85. Martinez-Almagro, A.; Almenar Garcia, V.; Martinez Sanjuan, V.; Hernandez Gil de Tejada, T.; Lorente Montalvo, P. Retroaortic left renal vein: A report of six cases. Surg. Radiol. Anat. 1992, 14, 361–366. [Google Scholar] [CrossRef]
  86. Monkhouse, W.S.; Khalique, A. The adrenal and renal veins of man and their connections with azygos and lumbar veins. J. Anat. 1986, 146, 105–115. [Google Scholar] [PubMed]
  87. 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. [Google Scholar] [CrossRef]
  88. Reed, M.D.; Friedman, A.C.; Nealey, P. Anomalies of the left renal vein: Analysis of 433 CT scans. J. Comput. Assist. Tomogr. 1982, 6, 1124–1126. [Google Scholar] [CrossRef] [PubMed]
  89. Alexander, J.J.; Gewertz, B.L.; Lu, C.T.; Zarins, C.K. New criteria for placement of a prophylactic vena cava filter. Surg. Gynecol. Obstet. 1986, 163, 405–409. [Google Scholar] [PubMed]
  90. Beckmann, C.F.; Abrams, H.L. Renal venography: Anatomy, technique, applications, analysis of 132 venograms, and a review of the literature. Cardiovasc. Interv. Radiol. 1980, 3, 45–70. [Google Scholar] [CrossRef]
  91. Kramer, B. The incidence of the renal venous collar in South African blacks. S. Afr. Med. J. 1980, 57, 875–876. [Google Scholar]
  92. Lien, H.H.; Kolbenstvedt, A. Phlebographic appearances of the left renal and left testicular veins. Acta Radiol. Diagn. 1977, 18, 321–332. [Google Scholar] [CrossRef]
  93. Goswami, A.P. Anatomical variation of the renal veins with varicosity presenting as pseudotumor of the kidney. J. Urol. 1976, 116, 648–649. [Google Scholar] [CrossRef] [PubMed]
  94. Royster, T.S.; Lacey, L.; Marks, R.A. Abdominal aortic surgery and the left renal vein. Am. J. Surg. 1974, 127, 552–554. [Google Scholar] [CrossRef] [PubMed]
  95. Davis, C.J., Jr.; Lundberg, G.D. Retroaortic left renal vein, a relatively frequent anomaly. Am. J. Clin. Pathol. 1968, 50, 700–703. [Google Scholar] [CrossRef] [PubMed]
  96. Ross, J.A.; Samuel, E.; Millar, D.R. Variations in the renal vascular pedicle. (An anatomical and radiological study with particular reference to renal transplantation). Br. J. Urol. 1961, 33, 478–485. [Google Scholar] [CrossRef] [PubMed]
  97. Reis, R.H.; Esenther, G. Variations in the pattern of renal vessels and their relation to the type of posterior vena cava in man. Am. J. Anat. 1959, 104, 295–318. [Google Scholar] [CrossRef] [PubMed]
  98. Royster, T.S. Thrombophlebitis after vena caval clipping. Am. J. Surg. 1967, 113, 754–756. [Google Scholar] [CrossRef] [PubMed]
  99. Mazengenya, P. Multiple variations of the renal and testicular vessels: Possible embryological basis and clinical importance. Surg. Radiol. Anat. 2016, 38, 729–733. [Google Scholar] [CrossRef] [PubMed]
  100. Raheem, O.A.; O’Brien, M.; Glacken, P.; Mohan, P.; Hickey, D.P. A review of the anatomical variations of the posterior tributaries of the left renal vein. Ir. J. Med. Sci. 2008, 177, 59–62. [Google Scholar] [CrossRef] [PubMed]
  101. Rydberg, J.; Kopecky, K.K.; Tann, M.; Persohn, S.A.; Leapman, S.B.; Filo, R.S.; Shalhav, A.L. Evaluation of prospective living renal donors for laparoscopic nephrectomy with multisection CT: The marriage of minimally invasive imaging with minimally invasive surgery. Radiographics 2001, 21, S223–S236. [Google Scholar] [CrossRef]
  102. Hostiuc, S.; Rusu, M.C.; Negoi, I.; Dorobanțu, B.; Grigoriu, M. Anatomical variants of renal veins: A meta-analysis of prevalence. Sci. Rep. 2019, 9, 10802. [Google Scholar] [CrossRef]
  103. Steinmuller, D.; Novick, A.; Braun, W.; Vidt, D.; Nakamoto, S. Renal transplantation of patients on chronic peritoneal dialysis. Am. J. Kidney Dis. 1984, 3, 436–439. [Google Scholar] [CrossRef] [PubMed]
  104. Stratta, R.J.; D’Alessandro, A.M.; Belzer, F.O. Renal vein reconstruction with interposition allografts in cadaveric renal transplantation. Transpl. Int. 1988, 1, 86–90. [Google Scholar] [CrossRef] [PubMed]
  105. Andreoli, S.P. Acute renal failure in the newborn. Semin. Perinatol. 2004, 28, 112–123. [Google Scholar] [CrossRef]
  106. Lorenz, J.M.; Regalado, S.; Navuluri, R.; Zangan, S.; Vanha, T.; Funaki, B. Transhepatic guidance of translumbar hemodialysis catheter placement in the setting of chronic infrarenal IVC occlusion. Cardiovasc. Interv. Radiol. 2010, 33, 635–638. [Google Scholar] [CrossRef]
Figure 1. Flow search diagram [12].
Figure 1. Flow search diagram [12].
Jcm 13 03689 g001
Figure 2. Geographic distribution of studies and subjects included in this review.
Figure 2. Geographic distribution of studies and subjects included in this review.
Jcm 13 03689 g002
Figure 3. Retroaortic left renal vein. AA: abdominal aortic; ICV: inferior caval vein; CLRV: circumaortic left renal vein; LK: left kidney.
Figure 3. Retroaortic left renal vein. AA: abdominal aortic; ICV: inferior caval vein; CLRV: circumaortic left renal vein; LK: left kidney.
Jcm 13 03689 g003
Figure 4. Circumaortic left renal vein. AA: abdominal aortic; ICV: inferior caval vein; CLRV circumaortic left renal vein; LK: left kidney.
Figure 4. Circumaortic left renal vein. AA: abdominal aortic; ICV: inferior caval vein; CLRV circumaortic left renal vein; LK: left kidney.
Jcm 13 03689 g004
Figure 5. Multiple renal veins. AA: abdominal aortic; ICV: inferior caval vein; RK: right kidney; RRA3 right renal arteries; RRV1, RRV2, RRV3: right renal vein.
Figure 5. Multiple renal veins. AA: abdominal aortic; ICV: inferior caval vein; RK: right kidney; RRA3 right renal arteries; RRV1, RRV2, RRV3: right renal vein.
Jcm 13 03689 g005
Figure 6. Multiple RV forest plot.
Figure 6. Multiple RV forest plot.
Jcm 13 03689 g006
Figure 7. Multiple RV funnel plot.
Figure 7. Multiple RV funnel plot.
Jcm 13 03689 g007
Figure 8. RV course forest plot.
Figure 8. RV course forest plot.
Jcm 13 03689 g008
Figure 9. RV course funnel plot.
Figure 9. RV course funnel plot.
Jcm 13 03689 g009
Figure 10. Forest plot branches RV.
Figure 10. Forest plot branches RV.
Jcm 13 03689 g010
Figure 11. Funnel plot branches RV.
Figure 11. Funnel plot branches RV.
Jcm 13 03689 g011
Figure 12. Forest plot unusual origin of RV.
Figure 12. Forest plot unusual origin of RV.
Jcm 13 03689 g012
Figure 13. Funnel plot unusual origin of RV.
Figure 13. Funnel plot unusual origin of RV.
Jcm 13 03689 g013
Figure 14. Graphic of AQUA checklist for included studies.
Figure 14. Graphic of AQUA checklist for included studies.
Jcm 13 03689 g014
Table 1. Characteristics of included studies.
Table 1. Characteristics of included studies.
Author and YearNumber of PatientsIncidence and CharacteristicsStatistical ValueGeographic RegionSexLaterality
Pedrao, 2023 [13]Observational
N = 1
Double RRV.Not mentioned.Brazil1 maleRight
Silva, 2021 [14]Observational
N = 1
Multiple retroaortic LRV.Not mentioned.Brazil1 maleLeft
Pradeep, 2020 [15]Observational
N = 188
Double RRV (12 cases—6.3%). Retroaortic LRV (4 cases—2.1%).Not mentioned.NepalNot specifiedBilateral
Salimy et al., 2020 [16]Observational
N = 1
Double RRV.
Right kidney with double collector system.
Not mentioned.USA1 maleRight
Fontana, 2018 [17]Observational
N = 1
Duplication of circumaortic RV.Not mentioned.Italy1 maleLeft
Tatarano et al., 2019 [18]Observational
N = 120
Circumaortic LRV (6 cases). Retroaortic LRV (1 case).There was no significant incidence between donors with or without abnormalities on their LRV.JapanNot specifiedLeft
Dunnwald, 2019 [19]Observational
N = 1
Triple RRV (1 case).Not mentioned.USA1 maleBilateral
Shaheen, 2018 [6]Observational
N = 50
Double RRV (28 cases—56%), triple (13 cases—26%), quadruple (5 cases—10%).Not mentioned.Pakistan50 malesBilateral
Hassan, 2017 [20]Observational
N = 63
Double RV (2 cases—3%), triple (2 cases—3%), quadruple (1 case—2%).No significant differences between cadavers with or
without variations in renal vasculature and age of death (p = 0.67) or gender
(p = 0.71).
Egypt32 males
31 females
Bilateral
Nambur, 2017 [21]Observational
N = 60
Circumaortic LRV (2 cases—3.3%). Retroaortic LRV (5 cases—8.3%).
Double RRV (3 cases—5%). Right gonadal vein draining into RRV (1 case—0.3%).
Not mentioned.IndiaNot specifiedBilateral
Ayaz, 2016 [22]Observational
N = 222
Circumaortic LRV (7 cases—3.15%).
Retroaortic LRV (6 cases—2.7%).
Not mentioned.Turkey116 males
106 females
Left
Çınar, 2016 [23]Observational
N = 504
Circumaortic LRV (26 cases—5.2%). Retroaortic LRV (21 cases—4.2%).
RRV: double (97 cases—19.2%), triple (11 cases—2.2%), quadruple (1 case—0.2%).
No associations were found between sex and the presence of RA or RV variations (p = 0.630 and 0.650, respectively).Turkey317 males
187 females
Bilateral
Duran, 2016 [24]Observational
N = 23
Retroaortic LRV (2 cases—8.7%).Not mentioned.Colombia12 males
1 females
Left
Kumaresan, 2016 [25]Observational
N = 100
Retroaortic LRV (4 cases—4%). Multiple RV (19 cases—19%)Not mentioned.IndiaNot specifiedBilateral
Pandya, 2016 [26]Observational
N = 200
Circumaortic LRV (8 cases—4%). Retroaortic LRV (5 cases—2.5%).
Double LRV (2 cases—1%)
Double RRV (61 cases—30.5%), triple (5 cases—2.5%).
Not mentioned.IndiaNot specifiedBilateral
Staśkiewicz, 2016 [27]Observational
N = 996
Circumaortic or retroaortic courses of the LRV in 99 cases (10%).No significant difference was observed in the type of RV course between
men and women (c2 = 1.22, p = 0.543).
Poland481 males
515 females
Bilateral
Bouzouita et al., 2015 [28]Observational
N = 71
Retroaortic LRV (1 case—1.4%).
Double LRV (3 cases—4.2%). Double RRV (5 cases—7%).
Not mentioned.TunisiaNot specifiedBilateral
Heidler, 2015 [29]Observational
N = 7929
Retroaortic LRV (61 cases—0.77%).Not mentioned.Austria4781 males
3148 females
Left
Reginelli, 2015 [30]Observational
N = 921
Multiple RV (94 cases—10.2%).
Retroaortic RV (219 cases—23.8%).
Not mentioned.Italy418 males
503 females
Bilateral
Resorlu, 2015 [31]Observational
N = 680
Retroaortic LRV (36 cases—5.4%). Circumaortic LRV (17 cases—2.5%).
Multiple RV (46 cases—6.8%).
Hematuria was detected in 23.5% of patients with circumaortic LRV
anomaly and 10.1% of patients without anomaly (p = 0.074). Hematuria was found in 21.7%
of patients with multiple RV and 9.6% in those without the anomaly (p = 0.009).
Turkey391 males
289 females
Left
Zhu, 2015 [32]Observational
N = 1452
Circumaortic LRV (31 cases—2.1%). Retroaortic LRV (30 cases—2.1%).No statistically significant correlation found between left/right
RV variations and sex (p > 0.05).
ChinaNot specifiedBilateral
Ballesteros, 2014 [33]Observational
N = 312
Circumaortic LRV (1 case—0.32%). Retroaortic LRV (2 cases—0.64%).
Double LRV (1 case—0.32%).
Double RRV (28 cases—8.9%), triple (5 cases—1.6%).
No significant difference between the presence of
additional veins in men and women (p = 0.452) and extrahilar origin between RRV and LRV (p = 0.768).
Colombia129 males
27 females
Bilateral
Boyaci, 2014 [34]Observational
N = 746
Circumaortic LRV (18 cases—2.4%). Retroaortic LRV (55 cases—7.4%).No significant difference between the presence of variations [LRV (p = 0.801), RLRV (p = 0.551), CLRV (p = 0.823)] and sex.Turkey395 males
351 females
Left
Ferreira, 2014 [35]Observational
N = 1
Retroaortic LRV.
Multiple RV.
29 to 65% of pyeloureteral obstructions were related to anomalies in the path of the vessels crossing the renal pelvis.Colombia1 malesBilateral
Lavy et al., 2015 [36]Observational
N = 1
Multiple RV.Not mentioned.France1 malesBilateral
Rashid, 2014 [37]Observational
N = 100
Circumaortic LRV (3 cases). Retroaortic LRV (5 cases).
Double RRV (16 cases—16%), triple (1 case—1%).
Not mentioned.Iran91 males
9 females
Bilateral
Șahin, 2014 [38]Observational
N = 2189
Circumaortic LRV (6 cases—0.3%). Retroaortic LRV (44 cases—2%).Not mentioned.TurkeyNot specifiedLeft
Dilli, 2013 [39]Observational
N = 1204
Circumaortic LRV (25 cases—2.1%). Retroaortic LRV (38 cases—3.2%).Significant correlation between retroaortic LRV and gender (p = 0.036).Turkey642 males
562 females
Left
Eid et al., 2013 [40]Observational
N = 1
LRV origin: IVC. End: RRV.Not mentioned.Japan1 maleLeft
Poyraz, 2013 [41]Observational
N = 1000
Circumaortic LRV (3 cases—0.3%). Retroaortic LRV (65 cases—6.5%).Diameters of the RRV and LRV were not significantly different (p = 0.1).
Diameter of the anterior LRV was significantly greater than contralateral RV in its widest portion (p = 0.04).
Turkey537 males
463 females
Left
Tao, 2013 [42]Observational
N = 378
Circumaortic LRV (8 cases—2.1%). Retroaortic LRV (7 cases—1.85%).Not mentioned.China197 males
181 females
Bilateral
Apisarnthanarak, 2012 [43]Observational
N = 65
Circumaortic LRV (1 case—1.5%). Retroaortic LRV (1 case—1.5%).
Double LRV (1 case—1.5%).
Double RRV (19 cases—29.2%), triple (4 cases—6.2%).
Right gonadal vein draining into the RRV (4 cases—6.2%).
Not mentioned.Thailand25 males
40 females
Bilateral
Atalar, 2012 [44]Observational
N = 739
Circumaortic LRV (6 cases—0.8%). Retroaortic LRV (17 cases—2.3%).Not mentioned.Turkey425 males
314 females
Left
Bouali et al., 2012 [45]Observational
N = 120
Circumaortic LRV (6 cases—5%). Retroaortic LRV (5 cases—4.17%).
Double RRV (22 cases—18.3%), triple (2 cases—1.7%).
Not mentioned.France79 males
41 females
Bilateral
Dilli, 2012 [46]Observational
N = 2644
Circumaortic LRV (27 cases—1.02%). Retroaortic LRV (44 cases—1.66%).No statistically significant gender difference was found between LRV variations (p = 0.83).Turkey1204 males
1440 females
Left
Gupta, 2011 [47]Observational
N = 30
Circumaortic LRV (2 cases—6.6%). Retroaortic LRV (2 cases—6.6%).
Double LRV (1 case—3.3%).
Double RRV (1 case—3.3%).
Not mentioned.IndiaNot specifiedBilateral
Yi et al., 2012 [48]Observational
N = 3
Circumaortic LRV (1 case). Retroaortic LRV (1 case).Not mentioned.Japan1 male
2 females
Left
Costa et al., 2011 [49]Observational
N = 254
Circumaortic LRV (1 case). Retroaortic LRV (3 cases).
Double LRV (4 cases—1.5%).
Double RRV (24 cases—9.8%).
Dominance of venous variations on the right side, 12 times greater than on the left.BrazilNot specifiedBilateral
Kulkarni, 2011 [50]Observational
N = 102
Circumaortic RV (5 cases—5%). Retroaortic RV (1 case—1%).
Multiple RV (7 cases—7%).
Not mentioned.USANot specifiedNot specified
Li et al., 2011 [51]Observational
N = 61
Anastomosis between the LRV and hemiazygos vein (51 cases—83.6%).Significant differences when comparing operation time. Type 4 took longer (p < 0.05), type 5 shorter time (p < 0.05).China32 males
29 females
Left
Favaro et al., 2009 [52]Observational
N = 1
Venous communication between LRV and RRV. Kidneys without any relation to the IVC or common iliac veins.Not mentioned.Brazil1 maleBilateral
Turkvatan, 2009 [53]Observational
N = 59
Circumaortic LRV (2 cases—3.3%). Retroaortic LRV (3 cases—5%).
Multiple RV (3 cases—5%).
Greater sensitivity and specificity of MDCT for renal venous anomalies.Turkey32 males
27 females
Bilateral
Kaneko et al., 2008 [54]Observational
N = 190
Multiple RV (25 cases—13%).Not mentioned.JapanNot specifiedBilateral
Mir et al., 2008 [55]Observational
N = 1
Double RV bilaterally.Not mentioned.IndiaNot specifiedBilateral
Natsis, 2008 [56]Observational
N = 319
Circumaortic LRV (8 cases—2.5%).Not mentioned.Greece173 males
146 females
Left
Tombul, 2008 [57]Observational
N = 60
Multiple RV (9 cases—15%)Sensitivity of MDCT angiography for veins was 93%.TurkeyNot specifiedBilateral
Yagci, 2008 [58]Observational
N = 783
Circumaortic LRV (15 cases—2%). Retroaortic LRV (23 cases—3%).
Double retroaortic vein (4 cases—0.5%).
No statistically significant difference in ages.TurkeyNot specifiedLeft
Holt, 2007 [59]Observational
N = 278
Retroaortic LRV (9 cases—3.2%).Not mentioned.UK278 malesLeft
Karaman, 2007 [60]Observational
N = 1856
Circumaortic LRV (17 cases—8.9%). Retroaortic LRV (68 cases—3.6%).Not mentioned.TurkeyNot specifiedLeft
Karazincir, 2007 [61]Observational
N = 277
Retroaortic LRV in patients (13 cases—9.3%) and controls (3 cases—2.2%).Significantly higher incidence of varicocele in patients compared to controls (p = 0.018).TurkeyNot specifiedLeft
Koc, 2007 [62]Observational
N = 1120
Circumaortic RV (62 cases—5.5%). Retroaortic RV (53 cases—4.7%).
Multiple RV (210 cases—18.8%).
Not mentioned.Turkey588 males
532 females
Bilateral
Raman, 2007 [63]Observational
N = 126
Circumaortic LRV (10 cases—8%). Retroaortic LRV (3 cases—2%).
Double LRV (10 cases—8%).
Double RRV (28 cases—22%), triple (2 cases—2%).
Not mentioned.USA57 males
69 females
Bilateral
Namasivayam, 2006 [64]Observational
N = 48
Circumaortic LRV (1 case—2%). Retroaortic LRV (2 cases—4%).
Double RRV (13 cases—27%), triple (1 case—2%).
Venous phase images showed significantly greater opacification of the left renal, gonadal, adrenal, and lumbar veins (p < 0.05).USA20 males
28 females
Bilateral
Arslan, 2005 [65]Observational
N = 1125
Retroaortic LRV (19 cases—1.68%).Not mentioned.Turkey573 males
552 females
Left
Kawamoto, 2005 [66]Observational
N = 100
Circumaortic LRV (3 cases—3%). Retroaortic LRV (2 cases—2%).
Small posterior branch that runs behind the aorta and drains into the IVC (6 cases—6%).
Not mentioned.USANot specifiedLeft
Klemm, 2005 [67]Observational
N = 86
Retroaortic LRV (1 case).Not mentioned.Germany86 femalesLeft
Janschek, 2004 [7]Observational
N = 119
Circumaortic LRV (7 cases—6%). Retroaortic LRV (3 cases—2.5%).
Double LRV (7 cases—5.9%), triple (1 case—0.8%).
Double RRV (21 cases—18%), triple (6 cases—5%).
Not mentioned.Austria58 males
61 females
Bilateral
Lin, 2004 [68]Observational
N = 170
Circumaortic LRV (16 cases—9.4%). Retroaortic LRV (2 cases—1.2%).Groups 1 and 2 were similar in operation time (p = 0.90), blood loss (p = 0.45), warm ischemia time (p = 0.14), and hospital stay (p = 0.45).USANot specifiedLeft
Yeh, 2004 [69]Observational
N = 186
Precaval RRV (9 cases—4.8%).Not mentioned.USANot specifiedRight
Yesidag, 2004 [70]Observational
N = 1003
Circumaortic LRV (23 cases—3.2%). Retroaortic LRV (9 cases—0.9%).Not mentioned.TurkeyNot specifiedLeft
Senecail et al., 2003 [71]Observational
N = 2
Circumaortic LRV (1 case).
Retroaortic LRV (1 case).
Not mentioned.France1 male
1 female
Left
Duques, 2002 [72]Observational
N = 34
Circumaortic LRV (1 case—2.9%). Double LRV (3 cases—8.9%).Not mentioned.Brazil24 males
10 females
Left
Sebe et al., 2002 [73]Observational
N = 88
Left adrenal vein that drains into a double RV (4 cases—4.5%).Not mentioned.FranceNot specifiedBilateral
Aljabri, 2001 [74]Observational
N = 1788
Circumaortic LRV (29 cases—1.62%).
Retroaortic LRV (57 cases—3.18%).
Not mentioned.Canada929 males
859 females
Left
Shindo, 2000 [75]Observational
N = 166
Circumaortic LRV (1 case).Not mentioned.Japan3 males
1 females
Left
Yoshinag, 2000 [76]Observational
N = 203
Retroaortic LRV (1 case).Not mentioned.JapanNot specifiedLeft
Satyapal, 1999 [77]Observational
N = 1008
Circumaortic LRV (301 cases—30%). Retroaortic LRV (71 cases—7.1%).
Additional RV (60 cases—6%).
Not mentioned.South AfricaNot specifiedLeft
Pozniak, 1998 [78]Observational
N = 205
Circumaortic LRV (17 cases—8.3%). Retroaortic LRV (6 cases—2.9%).Not mentioned.USA90 males
115 females
Bilateral
Trigaux, 1998 [79]Observational
N = 1014
Circumaortic LRV, (64 cases—6.3%). Retroaortic LRV (38 cases—3.7%).The distance between the entrance to the IVC in case of a circumaortic variation and the distance in the case of retroaortic RV were not statistically different (p = 0.6).Belgium572 males
442 females
Left
Baptista-Silva et al., 1997 [80]Observational
N = 342
Circumaortic LRV (6 cases—1.75%).
Retroaortic LRV (8 cases—2.3%).
Double RRV (9 cases—2.63%), triple (3 cases—0.87%).
Right gonadal vein draining into the RRV (1 case—0.3%).
Not mentioned.Brazil134 males
208 females
Bilateral
Hicks, 1995 [81]Observational
N = 108
Circumaortic LRV (11 cases—10%). Retroaortic LRV (2 cases—1.85%).
Double LRV (5 cases—4.6%), triple (1 case—0.92%).
Double RRV (18 cases—16.6%), triple (4 cases—3.7%).
No statistically significant difference between the 108
patients included and the 78 excluded regarding the indication for the procedure or demographic information such as sex, age, height, or weight.
Renal venography was more sensitive in detecting both significant
(p < 0.001) and insignificant (p < 0.001) abnormalities.
USA51 males
57 females
Bilateral
Kaufman, 1995 [82]Observational
N = 150
Circumaortic LRV (8 cases—5%). Retroaortic LRV (10 cases—7%).
Multiple RRV (12 cases—8%).
Not mentioned.USANot specifiedBilateral
Satyapal, 1995 [83]Observational
N = 153
Double RRV (40 cases—26%), triple (5 cases—3.2%).
Double LRV (4 cases—2.6%).
Not mentioned.South Africa131 males
22 females
Bilateral
Benedetti-Panici, 1994 [84]Observational
N = 309
Circumaortic RV (3 cases—0.97%).Not mentioned.Italy309 femalesBilateral
Martinez-Almagro, 1992 [85]Observational
N = 116
Retroaortic LRV (6 cases—5%).Not mentioned.Spain94 males
22 females
Left
Hoeltl, 1990 [3]Observational
N = 4520
Circumaortic LRV (4 cases—0.08%).
Retroaortic LRV (29 cases—0.6%).
Not mentioned.AustriaNot specifiedLeft
Observational
N = 354
Circumaortic LRV (2 cases—0.5%). Retroaortic LRV (4 cases—1.2%).
Observational
N = 215
Circumaortic LRV (2 cases—0.9%). Retroaortic LRV (6 cases—2.8%).
Monkhouse, 1986 [86]Observational
N = 57
Circumaortic LRV (2 cases—3.5%). Double RRV (1 case—1.7%).
RRV drains into IVC lower than LRV (22 cases—38.5%).
RRV drains into IVC upper than LRV (4 cases—7%).
Not mentioned.UK25 embalmed (9 males and 16 females);
32 fresh postmortem (8 males and 24 females)
Bilateral
Mayo, 1983 [87]Observational
N = 1140
Circumaortic LRV (1 case—0.08%).Not mentioned.CanadaNot specifiedLeft
Reed, 1982 [88]Observational
N = 433
Circumaortic LRV (19 cases—4.4%). Retroaortic LRV (8 cases—1.8%).Not mentioned.USANot specifiedLeft
Alexander, 1981 [89]Observational
N = 1200
Circumaortic LRV (3 cases—0.25%). Retroaortic LRV (1 case—0.08%).Not mentioned.USANot specifiedLeft
Beckmann, 1980 [90]Observational
N = 132
Circumaortic venous ring (8 cases—6.06%).
Retroaortic LRV (1 case—0.75%).
Double RRV (13 cases—9.84%), triple (3 cases—2.27%).
Right gonadal vein draining into the RRV (4 cases—3%).
Not mentioned.USANot specifiedBilateral
Kramer, 1980 [91]Observational
N = 193
Circumaortic RV (10 cases—5%).Not mentioned.South Africa140 males
53 females
Left
Lien, 1977 [92]Observational
N = 100
Circumaortic LRV (10 cases—10%). Retroaortic LRV (2 cases—2%).Not mentioned.Norway100 malesLeft
Goswami, 1976 [93]Observational
N = 1
Double LRV.Not mentioned.USA1 femaleLeft
Royster, 1974 [94]Observational
N = 159
Circumaortic LRV (1 case—0.6%). Retroaortic LRV (3 cases—1.8%), Double LRV (1 case—0.6%).Not mentioned.USANot specifiedLeft
Royster, 1974 [94]Observational
N = 228
Circumaortic LRV (1 case—0.43%). Retroaortic LRV (2 cases—0.8%).Not mentioned.USANot specifiedLeft
Davis, 1968 [95]Observational
N = 270
Circumaortic LRV (4 cases—1.5%). Retroaortic LRV (5 cases—1.8%).Not mentioned.USA9 malesLeft
Ross, 1961 [96]Observational
N = 34
Double RRV (7 cases—20.5%).
Double LRV (1 case—3%).
Not mentioned.Scotland16 males
18 females
Bilateral
Reis, 1959 [97]Observational
N = 500
Circumaortic RV (30 cases—6%). Retroaortic LRV (12 cases—2.4%).
Double LRV (4 cases—0.8%)
Double RRV (51 cases—10.2%),
triple (3 cases—0.6%).
Not mentioned.USA437 males
63 females
Bilateral
RV: renal vein; RRV: right renal vein; LRV: left renal vein; RLRV: retroaortic left renal vein; CLRV: circumaortic left renal vein; IVC: inferior vena cava.
Table 2. Prevalence studies included.
Table 2. Prevalence studies included.
Author and YearTotal NPrevalenceMultiple RVRV Course (Circumaortic or Retroaortic)RV RamificationsUnusual Origin of RV
Pedrao, 2023 [13]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Silva 2021 [14]1Multiple RV: 1
RV course: 1
11Not mentionedNot mentioned
Pradeep, 2020 [15]188Multiple RV: 12
RV course: 4
124Not mentionedNot mentioned
Salimy et al., 2020 [16]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Fontana, 2018 [17]1Multiple RV: 1
RV course: 1
11Not mentionedNot mentioned
Tatarano et al., 2019 [18]120RV course: 7Not mentioned7Not mentionedNot mentioned
Dunnwald, 2019 [19]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Shaheen, 2018 [6]50Multiple RV: 4646Not mentionedNot mentionedNot mentioned
Hassan, 2017 [20]63Multiple RV: 55Not mentionedNot mentionedNot mentioned
Nambur, 2017 [21]60Multiple RV: 3
RV course: 7
37Not mentionedNot mentioned
Ayaz, 2016 [22]222RV course: 13Not mentioned13Not mentionedNot mentioned
Çınar, 2016 [23]504Multiple RV: 109
RV course: 47
10947Not mentionedNot mentioned
Duran, 2016 [24]23RV course: 2Not mentioned2Not mentionedNot mentioned
Kumaresan, 2016 [25]100Multiple RV: 19
RV course: 4
194Not mentionedNot mentioned
Pandya, 2016 [26]200Multiple RV: 66
RV course: 13
6613Not mentionedNot mentioned
Staśkiewicz, 2016 [27]996RV course: 99Not mentioned99Not mentionedNot mentioned
Bouzouita et al., 2015 [28]71Multiple RV: 8
RV course: 1
81Not mentionedNot mentioned
Heidler, 2015 [29]7929RV course: 61Not mentioned61Not mentionedNot mentioned
Mazengenya, 2015 [99]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Reginelli, 2015 [30]921Multiple RV: 94
RV course: 219
94219Not mentionedNot mentioned
Resorlu, 2015 [31]680Multiple RV: 46
RV course: 53
4653Not mentionedNot mentioned
Ballesteros, 2014 [33]312Multiple RV: 34
RV course: 3
343Not mentionedNot mentioned
Boyaci, 2014 [34]746RV course: 73Not mentioned73Not mentionedNot mentioned
Ferreira, 2014 [35]1Multiple RV: 1
RV course: 1
11Not mentionedNot mentioned
Lavy et al., 2015 [36]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Rashid, 2014 [37]100Multiple RV: 17
RV course: 8
178Not mentionedNot mentioned
Șahin, 2014 [38]2189RV course: 50Not mentioned50Not mentionedNot mentioned
Dilli, 2013 [39]1204RV course: 63Not mentioned63Not mentionedNot mentioned
Poyraz, 2013 [41]1000RV course: 68Not mentioned68Not mentionedNot mentioned
Tao, 2013 [42]378RV course: 15Not mentioned15Not mentionedNot mentioned
Apisarnthanarak, 2012 [43]65Multiple RV: 24
RV course: 2
RV ramifications: 4
2424Not mentioned
Atalar, 2012 [44]739RV course: 23Not mentioned23Not mentionedNot mentioned
Bouali et al., 2012 [45]120Multiple RV: 24.
RV course: 11
2411Not mentionedNot mentioned
Dilli, 2012 [46]2644RV course: 71Not mentioned71Not mentionedNot mentioned
Gupta, 2011 [47]30Multiple RV: 2
RV course: 4
24Not mentionedNot mentioned
Yi et al., 2012 [48]3RV course: 2Not mentioned2Not mentionedNot mentioned
Costa et al., 2011 [49]254Multiple RV: 28
RV course: 4
284Not mentionedNot mentioned
Kulkarni, 2011 [50]102Multiple RV: 7
RV course: 6
76Not mentionedNot mentioned
Li et al., 2011 [51]61RV ramification: 51Not mentionedNot mentioned51Not mentioned
Turkvatan, 2009 [53]59Multiple RV: 3
RV course: 5
35Not mentioned4
Kaneko et al., 2008 [54]190Multiple RV: 2525Not mentionedNot mentionedNot mentioned
Mir et al., 2008 [55]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Natsis, 2008 [56]319RV course: 8Not mentioned8Not mentionedNot mentioned
Tombul, 2008 [57]60Multiple RV: 99Not mentionedNot mentionedNot mentioned
Yagci, 2008 [58]783RV course: 42Not mentioned42Not mentionedNot mentioned
Holt, 2007 [59]278RV course: 9Not mentioned9Not mentionedNot mentioned
Karaman, 2007 [60]1856RV course: 85Not mentioned85Not mentioned89
Karazincir, 2007 [61]277RV course: 16Not mentioned16Not mentionedNot mentioned
Koc, 2007 [62]1120Multiple RV: 210
RV course: 115
210115Not mentionedNot mentioned
Raman, 2007 [63]126Multiple RV: 40
RV course: 13
4013Not mentionedNot mentioned
Namasivayam, 2006 [64]48Multiple RV: 14
RV course: 3
143Not mentionedNot mentioned
Arslan, 2005 [65]1125RV course: 19Not mentioned19Not mentionedNot mentioned
Kawamoto, 2005 [66]100RV course: 5 RV ramifications: 6Not mentioned56Not mentioned
Klemm, 2005 [67]86RV course: 1Not mentioned1Not mentionedNot mentioned
Janschek, 2004 [7]119Multiple RV: 35
RV course: 10
3510Not mentionedNot mentioned
Lin, 2004 [68]170RV course: 18Not mentioned16Not mentionedNot mentioned
Yeh, 2004 [69]186RV course: 9Not mentioned9Not mentionedNot mentioned
Yesidag, 2004 [70]1003RV course: 32Not mentioned32Not mentionedNot mentioned
Senecail et al., 2003 [71]2RV course: 2Not mentioned2Not mentionedNot mentioned
Duques, 2002 [72]34Multiple renal vein: 3
RV course: 1
31Not mentionedNot mentioned
Sebe et al., 2002 [73]88Multiple RV: 4
RV origin: 4
4Not mentionedNot mentioned4
Aljabri, 2001 [74]1788RV course: 86Not mentioned86Not mentionedNot mentioned
Shindo, 2000 [75]166RV course: 1Not mentioned1Not mentionedNot mentioned
Yoshinag, 2000 [76]203RV course: 1Not mentioned1Not mentionedNot mentioned
Satyapal, 1999 [77]1008Multiple RV: 60
RV course: 372
60372Not mentionedNot mentioned
Pozniak, 1998 [78]205RV course: 23Not mentioned23Not mentionedNot mentioned
Trigaux, 1998 [79]1014RV course: 102Not mentioned102Not mentionedNot mentioned
Baptista-Silva et al., 1997 [80]342Multiple RV: 12
RV course: 14
RV ramifications: 1
12141Not mentioned
Hicks, 1995 [81]108Multiple RV: 28
RV course: 13
2813Not mentionedNot mentioned
Kaufman, 1995 [82]150Multiple RV: 12
RV course: 18
1218Not mentionedNot mentioned
Satyapal, 1995 [83]153Multiple RV: 4949Not mentionedNot mentionedNot mentioned
Benedetti-Panici, 1994 [84]309RV course: 3Not mentioned3Not mentionedNot mentioned
Martinez-Almagro, 1992 [85]116RV course: 6Not mentioned6Not mentionedNot mentioned
Hoeltl, 1990 [3]5089RV course: 47Not mentioned47Not mentionedNot mentioned
Monkhouse, 1986 [86]57Multiple RV: 1
RV course: 2
RV origin: 26
12Not mentioned26
Mayo, 1983 [87]1140RV course: 1Not mentioned1Not mentionedNot mentioned
Reed, 1982 [88]433RV course: 27Not mentioned27Not mentionedNot mentioned
Alexander, 1981 [89]1200RV course: 4Not mentioned4Not mentionedNot mentioned
Beckmann, 1980 [90]132Multiple RV: 9
RV course: 16
RV ramifications: 4
9164Not mentioned
Kramer, 1980 [91]193RV course: 10Not mentioned10Not mentionedNot mentioned
Lien, 1977 [92]100RV course: 12Not mentioned12Not mentionedNot mentioned
Goswami, 1976 [93]1Multiple RV: 11Not mentionedNot mentionedNot mentioned
Royster, 1974 [94]159Multiple RV: 2
RV course: 5
25Not mentionedNot mentioned
Royster, 1974 [94]228RV course: 3Not mentioned3Not mentionedNot mentioned
Davis, 1968 [95]270RV course: 9Not mentioned9Not mentionedNot mentioned
Ross, 1961 [96]34Multiple RV: 88Not mentionedNot mentionedNot mentioned
Reis, 1959 [97]500Multiple RV: 58
RV course: 42
5842Not mentionedNotmentioned
RV: renal vein.
Table 3. Risk of bias of included studies. Risk of bias assessment according to the JBI critical appraisal checklist.
Table 3. Risk of bias of included studies. Risk of bias assessment according to the JBI critical appraisal checklist.
AuthorJBI Q1JBI Q2JBI Q3JBI Q4JBI Q5JBI Q6JBI Q7JBI Q8Bias Risk
Dunnwald et al., 2019 [19] Low
Eid et al., 2013 [40] Low
Favaro et al., 2009 [52] Low
Ferreira et al., 2014 [35] Low
Yi et al., 2012 [48] Low
Goswami et al., 1976 [93] Low
Mazengenya et al., 2015 [99] Low
Mir et al., 2008 [55] Low
Pedrao, 2023 [13] Low
Salimy et al., 2020 [16] Low
Senecail et al., 2003 [71] Low
Silva, 2021 [14] Low
Table 4. The Joanna Briggs Institute (JBI) critical appraisal checklist for case reports.
Table 4. The Joanna Briggs Institute (JBI) critical appraisal checklist for case reports.
(1) Were patient’s demographic characteristics clearly described?YesNoUnclearNot applicable
(2) Was the patient’s history clearly described and presented as a timeline?YesNoUnclearNot applicable
(3) Was the current clinical condition of the patient on presentation clearly described?YesNoUnclearNot applicable
(4) Were diagnostic tests or assessment methods results clearly described?YesNoUnclearNot applicable
(5) Was the intervention(s) or treatment procedure(s) clearly described?YesNoUnclearNot applicable
(6) Was the postintervention clinical condition clearly described?YesNoUnclearNot applicable
(7) Were adverse events (harms) or unanticipated events identified and described?YesNoUnclearNot applicable
(8) Does the case report provide takeaway lessons?YesNoUnclearNot applicable
Overall appraisal: Include ▢ exclude ▢ seek further info ▢.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Valenzuela Fuenzalida, J.J.; Vera-Tapia, K.; Urzúa-Márquez, C.; Yáñez-Castillo, J.; Trujillo-Riveros, M.; Koscina, Z.; Orellana-Donoso, M.; Nova-Baeza, P.; Suazo-Santibañez, A.; Sanchis-Gimeno, J.; et al. Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence. J. Clin. Med. 2024, 13, 3689. https://doi.org/10.3390/jcm13133689

AMA Style

Valenzuela Fuenzalida JJ, Vera-Tapia K, Urzúa-Márquez C, Yáñez-Castillo J, Trujillo-Riveros M, Koscina Z, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Sanchis-Gimeno J, et al. Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence. Journal of Clinical Medicine. 2024; 13(13):3689. https://doi.org/10.3390/jcm13133689

Chicago/Turabian Style

Valenzuela Fuenzalida, Juan Jose, Karla Vera-Tapia, Camila Urzúa-Márquez, Javiera Yáñez-Castillo, Martín Trujillo-Riveros, Zmilovan Koscina, Mathias Orellana-Donoso, Pablo Nova-Baeza, Alejandra Suazo-Santibañez, Juan Sanchis-Gimeno, and et al. 2024. "Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence" Journal of Clinical Medicine 13, no. 13: 3689. https://doi.org/10.3390/jcm13133689

APA Style

Valenzuela Fuenzalida, J. J., Vera-Tapia, K., Urzúa-Márquez, C., Yáñez-Castillo, J., Trujillo-Riveros, M., Koscina, Z., Orellana-Donoso, M., Nova-Baeza, P., Suazo-Santibañez, A., Sanchis-Gimeno, J., Bruna-Mejias, A., & Gutiérrez Espinoza, H. (2024). Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence. Journal of Clinical Medicine, 13(13), 3689. https://doi.org/10.3390/jcm13133689

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop