Trial clamping before division of the left renal vein.

Severe congestion of the left renal vein occurred in two patients after the vein was divided to improve access to the abdominal aorta. In one patient in whom hypoplasia of the right kidney was not previously recognized, acute renal failure followed. In the other patient renal vein congestion was relieved by interposing a synthetic graft between the hilar end of the cut renal vein and the vena cava. When division of the left renal vein is considered, preliminary temporary clamping is advised to predict the adequacy of alternative route of venous drainage of the kidney.