Adrenal Veins

venae suprarenales

The adrenal glands have a single dominant draining vein on each side with asymmetric anatomy. The right adrenal vein is short (5-10 mm) and drains directly and posterolaterally into the right IVC. The left adrenal vein is longer and typically joins the left renal vein rather than draining to the IVC directly. Both veins receive contributions from inferior phrenic veins, and their anatomy is highly variable.

Region: Abdomen

Clinical Relevance

Clinical Notes

The right adrenal vein's extremely short course from the adrenal gland directly to the posterolateral IVC makes right adrenalectomy the technically more demanding side, as inadvertent avulsion causes major IVC bleeding. In phaeochromocytoma surgery, early ligation of the adrenal vein before tumour manipulation is mandatory to prevent catecholamine surge. Adrenal vein sampling (AVS) is the gold standard test for primary hyperaldosteronism, distinguishing unilateral from bilateral adrenal adenoma by comparing aldosterone-to-cortisol ratios from each adrenal vein catheterised separately.

Pathology

Common Injuries & Conditions

Adrenal Vein Sampling for Primary Hyperaldosteronism

Selective cannulation of each adrenal vein with simultaneous cortisol-corrected aldosterone sampling distinguishes a unilateral Conn adenoma (lateralisation index greater than 4:1) from bilateral hyperplasia, guiding whether surgical adrenalectomy or medical management with aldosterone antagonists is appropriate.

Right Adrenal Vein Avulsion

The right adrenal vein's direct short drainage into the posterolateral IVC means inadvertent avulsion during right adrenalectomy causes difficult haemorrhage from the IVC wall, requiring immediate proximal-distal caval clamping and primary suture repair.