The left renal vein is endowed with a rich network of collaterals, therefore distal division does not jeopardize global renal function and this is true under particularly favourable conditions, even if the right kidney is missing. A woman presented with an enormous retroperitoneal liposarcoma and a carcinoma of the breast. She underwent a radical mastectomy and the resection of a 13 kg retroperitoneal tumor which required a right nephrectomy, segmental resection of the involved vena cava and reconstruction with a prosthesis joined to the left renal vein by a bovine carotid graft. This graft thrombosed shortly after surgery, without causing apparent damage to the residual kidney. The patient died 77 months after the operation, from diffuse recurrences of the breast cancer while renal function was never impaired. The left renal vein may be interrupted distally for many pathologies and then reconstructed or ligated definitively without renal function failure, even in monorenal patients if collaterals are well developed.

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