The ascending lumbar veins are paired paravertebral vessels connecting the common iliac veins below to the azygos vein on the right and hemiazygos on the left. They receive lumbar tributaries at each vertebral level and form a collateral pathway when the inferior vena cava is occluded.
The ascending lumbar veins serve as the primary collateral route in IVC obstruction or thrombosis, becoming visibly dilated on CT. They are an important anatomical landmark during retroperitoneal lymph node dissection and lumbar spinal surgery. Injury during posterior lumbar fusion can produce significant haemorrhage.
Iatrogenic laceration during posterior lumbar surgery or retroperitoneal dissection, producing rapid venous haemorrhage that is difficult to control due to the vessel depth and calibre.
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