Renocaval Bypass for Acute Renal Failure and Haematuria Following Left Renal Vein Ligation During Aorto-Bifemoral Bypass

Ligation of the left renal vein is an accepted manoeuvre where it is difficult to access the pararenal abdominal aorta for the open treatment of aortic occlusive or aneurysmal disease. There is some controversy regarding the long-term effect of this on renal function. We describe the case of a 37-year-old gentleman who underwent an elective aorto-bifemoral bypass for aorto-iliac occlusive disease with symptoms of short distance claudication, with intra-operative ligation of the left renal vein. This was complicated by post-operative acute renal failure and haematuria, with CT findings of left renal venous dilatation and peri-renal stranding. The patient underwent successful left renocaval bypass with reversed great saphenous vein, with subsequent resolution of haematuria and improvement in renal function. The syndrome of acute renal failure and haematuria is a rare but possible complication of left renal vein ligation during aortic surgery, and restoration of renal venous outflow via renocaval bypass in this instance was an effective method of treating this complication.