Left Renal Vein Reconstruction for Functional Paraganglioma Resection: A Case Study

Abstract

A 54-year-old woman with a history of uncontrolled hypertension was found to have a large retroperitoneal mass on the left side compressing the renal vein. Contrast-enhanced CT of the abdomen and pelvis demonstrated a sizable, highly vascular, encapsulated, and heterogeneous para-aortic retroperitoneal tumor causing renal vein compression. Laboratory evaluation of blood and urine catecholamines confirmed the tumor was functional. A multidisciplinary team comprising anesthesiologists and urologists coordinated the surgical plan. Since imaging suggested the lesion was inseparable from the pancreas, a midline transperitoneal approach was chosen. Although the tumor compressed the vein, no significant impairment of blood flow was evident on imaging. Intraoperatively, venous drainage into the renal vein was observed. Following tumor excision, the renal vein was reconstructed, with less than 20% reduction in its caliber. Postoperatively, the patient’s blood pressure stabilized, allowing discontinuation of antihypertensive medications. Many studies and case control investigations must be performed to find the main criteria and surgical limitations of left renal vein reconstruction and how the surgeries can be optimized with minimal risk of bleeding and infections.