A Cadaveric Case Report of Retroaortic Left Renal Vein in an Elderly Male With Multiple Known Comorbidities

This case report describes the discovery of a type 1 retroaortic left renal vein (RLRV) in an 83-year-old male cadaveric donor with multiple comorbidities. RLRV is an anatomical variant with an estimated incidence of 0.5-3.6%, with type 1 RLRV being the most common subtype. RLRV is typically asymptomatic, which aligns with the benign nature of the anatomical variation seen in this case. However, it is important to recognize that RLRV can be symptomatic. The hallmark manifestations of renal vein entrapment, colloquially known as the "nutcracker syndrome," include hematuria, proteinuria, flank pain, and varicocele, which are concurrent with the encasement of the renal vein between the aorta and surrounding anatomical structures. RLRV is typically diagnosed using multidetector CT (MDCT) or Doppler ultrasound (DUS). The therapeutic approach to symptomatic RLRV primarily encompasses conservative strategies, such as the administration of angiotensin-converting enzyme (ACE) inhibitors and aspirin, whereas surgical interventions are generally reserved for refractory cases, i.e., when conservative measures fail to alleviate the symptoms.