Aneurysm of the left ascending lumbar communicating vein: Its prevalence and possible association with nutcracker phenomenon

Published:February 25, 2022DOI:


      • The prevalence of ascending lumbar communicating vein (ALCV) is high in the adult population.
      • A narrower aortomesenteric angle and a greater compression ratio of the left renal vein (LRV) may cause ALCV aneurysm.
      • ALCV and the left gonadal vein merge in 9.6% of patients with preaortic LRV.



      To evaluate abdominal computed tomography (CT) studies in respect of the prevalence of the left ascending lumbar communicating vein (ALCV) and ALCV aneurysm and to identify possible causes of aneurysm development in the ALCV.


      Contrast-enhanced abdominal CT examinations were retrospectively investigated for the prevalence of the ALCV in the adult population. In patients with ALCV, the diameters of the following vessels were measured: ALCV, left renal vein (LRV) at two levels, compression ratio of the LRV (CR), left gonadal vein, right and left ascending lumbar veins (ALVs). The aortomesenteric angle was also measured for preaortic LRVs. ALCV aneurysm was noted during the assessment.


      Evaluation was made of 500 patients. ALCV was found in 240 patients (48%), more common in patients with retroaortic LRV and circumaortic LRV than in patients with preaortic LRV (p = 0.003). The mean diameter of the ALCV was 3.85 ± 2.06 mm. ALCV and the left gonadal vein merged to form a common vein draining into the LRV in 23 patients with preaortic LRV (9.6%). Of the patients with ALCV, 19 (8%) had aneurysm. The diameter of the left ALV and CR were significantly greater in patients with aneurysm than in patients without (p = 0.001 and 0.032, respectively). Patients with ALCV aneurysm had a significantly narrower aortomesenteric angle (p = 0.004).


      The results of this study indicated that a narrower aortomesenteric angle and a greater CR might play a role in the development of ALCV aneurysm.



      ALCV (Ascending lumbar communicating vein), ALV (Ascending lumbar vein), CR (Compression ratio), CT (Computed tomography), IVC (Inferior vena cava), LRV (Left renal vein), MIP (Maximum intensity projection), MPR (Multiplanar reconstructed)
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        • Chuang V.P.
        • Mena C.E.
        • Hoskins P.A.
        Congenital anomalies of the inferior vena cava. Review of embryogenesis and presentation of a simplified classification.
        Br J Radiol. 1979; 47: 206-213
        • Mayo J.
        • Gray R.
        • St Louis E.
        • Grosman H.
        • McLoughlin M.
        • Wise D.
        Anomalies of the inferior vena cava.
        AJR Am J Roentgenol. 1983; 140: 339-345
        • Bass J.E.
        • Redwine M.D.
        • Kramer L.A.
        • Huynh P.T.
        • Harris Jr., J.H.
        Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings.
        Radiographics. 2000; 20: 639-652
        • Eldefrawy A.
        • Arianayagam M.
        • Kanagarajah P.
        • Acosta K.
        • Manoharan M.
        Anomalies of the inferior vena cava and renal veins and implications for renal surgery.
        Cent Eur J Urol. 2011; 64: 4-8
        • Ahlberg N.E.
        • Bartley O.
        • Chidekel N.
        • Wahlqvist L.
        An anatomic and roentgenographic study of the communications of the renal vein in patients with and without renal carcinoma.
        Scand J Urol Nephrol. 1967; 1: 43-51
        • Pick James W.
        • Anson Barry J.
        The renal vascular pedicle: an anatomical study of 430 body-halves.
        J Urol. 1940; 44: 411-434
        • Lien H.H.
        • Kolbenstvedt A.
        Phlebographic appearances of the left renal and left testicular veins.
        Acta Radiol Diagn. 1977; 18: 321-332
        • Yao Y.
        • Okada Y.
        • Yamato M.
        • Ohtomo K.
        Communicating vein between the left renal vein and left ascending lumbar vein: incidence and significance on abdominal CT.
        Radiat Med. 2003; 21: 252-257
        • Tatarano S.
        • Enokida H.
        • Yamada Y.
        • Nishimura H.
        • Yoshino H.
        • Ishihara T.
        • et al.
        Anatomical variations of the left renal vein during laparoscopic donor nephrectomy.
        Transplant Proc. 2019; 51: 1311-1313
        • Sigmund G.
        • Bähren W.
        • Gall H.
        • Lenz M.
        • Thon W.
        Idiopathic varicoceles: feasibility of percutaneous sclerotherapy.
        Radiology. 1987; 164: 161-168
        • Lopez A.J.
        Female pelvic vein embolization: indications, techniques, and outcomes.
        Cardiovasc Intervent Radiol. 2015; 38: 806-820
        • Bittles M.A.
        • Hoffer E.K.
        Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome.
        Semin Interv Radiol. 2008; 25: 261-270
        • Sze D.Y.
        • Kao J.S.
        • Frisoli J.K.
        • McCallum S.W.
        • Kennedy II, W.A.
        • Razavi M.K.
        Persistent and recurrent postsurgical varicoceles: venographic anatomy and treatment with N-butyl cyanoacrylate embolization.
        J Vasc Interv Radiol. 2008; 19: 539-545
        • Lien H.H.
        • von Krogh J.
        Varicosity of the left renal ascending lumbar communicant vein: a pitfall in CT diagnosis.
        Radiology. 1984; 152: 484
        • Meanock C.I.
        • Ward C.S.
        • Williams M.P.
        The left ascending lumbar vein: a potential pitfall in CT diagnosis.
        Clin Radiol. 1988; 39: 565-566
        • Pilcher J.M.
        • Padhani A.R.
        Problem in diagnostic imaging: behind the left renal vein.
        Clin Anat. 1997; 10: 349-352<349::AID-CA12>3.0.CO;2-K
        • Jakhere S.G.
        • Yadav D.A.
        • Tuplondhe G.R.
        Case report: varicosity of the communicating vein between the left renal vein and the left ascending lumbar vein mimicking a renal artery aneurysm: report of an unusual site of varicose veins and a novel hypothesis to explain its association with abdominal pain.
        Indian J Radiol Imaging. 2011; 21: 24-27
        • Arslan S.
        • Sarıkaya Y.
        • Karcaaltincaba M.
        • Karaosmanoglu A.D.
        Aneurysm of the communicating vein between the left renal vein and left ascending lumbar vein mimicking retroperitoneal lymphadenopathy: a case report.
        Curr Med Imaging. 2021; 17: 644-647
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        • Initiative S.T.R.O.B.E.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Hangge P.T.
        • Gupta N.
        • Khurana A.
        • Quencer K.B.
        • Albadawi H.
        • Alzubaidi S.J.
        • et al.
        Degree of left renal vein compression predicts nutcracker syndrome.
        J Clin Med. 2018; 8: 107
        • Parker L.P.
        • Powell J.T.
        • Kelsey L.J.
        • Lim B.
        • Ashleigh R.
        • Venermo M.
        • et al.
        Morphology and hemodynamics in isolated common iliac artery aneurysms impacts proximal aortic remodeling.
        Arterioscler Thromb Vasc Biol. 2019; 39: 1125-1136
        • Kumar Y.
        • Hooda K.
        • Li S.
        • Goyal P.
        • Gupta N.
        • Adeb M.
        Abdominal aortic aneurysm: pictorial review of common appearances and complications.
        Ann Transl Med. 2017; 5: 256