Renal Vein Ligation

To the Editor.—  Certain comments should be made concerning the case report by E. R. Jennings, MD, and M. A. Glucksman, MD, in the recent LETTERS section of The Journal (213:1905, 1970).Left renal vein division and ligation has been done with no serious consequences for portal renal shunts,^1-3 splenorenal shunts,⁴ and as an aid in abdominal aortic surgery.⁵ Anatomically, this is possible because the left renal vein, in contradistinction to the right renal vein, has a number of tributaries through which collateral venous drainage is possible. The inferior phrenic and suprarenal tributaries enter from above; from below, and to the side come gonadal (spermatic and ovarian), capsular, lumbar, and ascending lumbar veins. Also communication is made with the azygos and hemiazygos veins (usually through the lumbars) and with the extensive set of internal and external vertebral plexuses by way of the intervertebral and lumbar veins.