Ovarian vein bypass for renal allograft salvage in iliac vein atrophy: A case report and review of literature

Figure 1 Preoperative computed tomography venography. A: Markedly atrophic left external iliac vein measuring approximately 3 mm in diameter (arrow). This small caliber was insufficient for adequate renal allograft venous drainage; B: Left ovarian (gonadal) vein measuring 3.7 mm in diameter at its maximal segment (arrow), identified as a potential alternative venous outflow pathway within the operative field.

Figure 2 Intraoperative findings. A: After clamp release, the left renal vein became markedly distended and the graft appeared congested and tense, consistent with inadequate outflow; B: Salvage bypass using an end-to-side great saphenous vein interposition graft from the renal vein to the left ovarian vein, creating an additional venous drainage pathway.

Figure 3 Follow-up ultrasonography at 8 months. A: Gray-scale imaging of the renal graft showing preserved corticomedullary differentiation without hydronephrosis; B: Color Doppler demonstrating homogeneous parenchymal perfusion; C: Spectral Doppler measurement at the renal vein showing an outflow volume of 219.3 mL/minute; D: Spectral Doppler measurement at the great saphenous vein conduit showing a flow of 67.6 mL/minute.

Figure 4 Follow-up magnetic resonance imaging at 8 months. A: Great saphenous vein conduit dilated to 9.09 mm (arrow); B: Left ovarian vein enlarged to 6.03 mm (arrow); C: Patent triple arterial anastomoses supplying the renal graft (arrows).