A “Dangerous Vessel” — Description of a potentially hazardous vein during para-aortic lymphadenectomy

Abstract

Background and Objectives: Tributaries of inferior vena cava (IVC) are not com pletely described. As IVC has a complex developmental origin, variations in the feeding vessels are common. The main objective of this study was to report the occurrence of any ventral tributary in the level 1 region of IVC. During the study, origin of such ventral tributary and course was also noted. Methodology: In a retrospective/prospective observational study from 2015 to 2018, comprising 168 para-aortic lymphadenectomy (PLA) procedures conducted at Department of Gynaecological Oncology, University Hospital of Ulm, Germany, the presence of ventral tributaries of IVC was evaluated. Results: Out of 148 retrospective cases of PLA, the presence of a prominent ventral tributary within 2 cm distance from the bifurcation of aorta was assumed in more than 60% cases. Within 20 prospectively assessed cases, the vein could be identified in 17 patients and was located within the right mesoureter. Only on one patient, this feeding vessel was draining into IVC at the level below the aortic bifurcation. Conclusion: In 85% of the prospectively assessed patients considered in the study, lymphadenectomy there was a constant ventral tributary feeding the IVC within 2 cm from the bifurcation of the aorta.

Keywords

• endometrial cancer
• ovarian cancer
• para-aortic lymphadenectomy
• surgical complications