Aorto–left renal vein fistula (ALRVF) is an uncommon complication of a ruptured abdominal aortic aneurysm (AAA) that can result in an indirect form of renal hypoperfusion from left renal vein (LRV) hypertension. Less common than aortocaval fistulas, ALRVFs usually involve retroaortic LRVs. Clinical features of ALRVF include acute kidney injury, varicocele, and often hematuria due to communication between the aorta and LRV. In addition to general imaging findings of aortocaval fistula, such as enlarged inferior vena cava, right heart enlargement, and pulmonary edema, imaging findings more specific to ALRVF include asymmetric hypoperfusion of the left kidney and engorged left gonadal veins. Primary open repair of the AAA with closure of the fistula, definitive endovascular repair, or endovascular repair as a bridge to open repair resolves the renal hypoperfusion and other imaging findings. We present a case of ALRVF associated with renal hypoperfusion that resolved after successful repair of the patient's aortic aneurysm.
Mehrsheikh et al. (2026) studied this question.