Left ovarian vein

The left ovarian vein is a blood vessel that drains deoxygenated blood from the left ovary and its surrounding structures, including the fallopian tube and parts of the broad ligament of the uterus. It originates from the ovarian venous plexus and ascends along the posterior abdominal wall in the retroperitoneal space.^[3] The left ovarian vein runs parallel to the left ovarian artery and the left ureter. Unlike the right ovarian vein, which drains directly into the inferior vena cava, the left ovarian vein drains into the left renal vein at the level of the second lumbar vertebra (L2). This anatomical difference affects the venous drainage pattern of the left side.

Anatomy

Origin

The left ovarian vein originates from the ovarian venous plexus, a network of small veins that drain venous blood from the left ovary, fallopian tube, and surrounding structures, including the broad ligament of the uterus. This plexus, located within the pelvis near the ovary, collects deoxygenated blood from the ovarian tissue and coalesces to form the single left ovarian vein. The venous plexus is closely associated with the ovarian artery and follows the same general path.

Course

The left ovarian vein ascends from the pelvis into the retroperitoneal space along the posterior abdominal wall. It follows a course through the suspensory ligament of the ovary (also called the infundibulopelvic ligament), which connects the ovary to the lateral pelvic wall. The left ovarian vein travels alongside the left ovarian artery, both of which are enclosed within the suspensory ligament as they move from the pelvic region into the abdominal cavity.^[5] As the left ovarian vein ascends, it runs in a posterior and lateral position relative to the peritoneum. The vein courses superiorly in a straight path, following the retroperitoneal route, and approaches the left renal vein near the left kidney.^[1] The vein lies anterior to the psoas major muscle and crosses over several important structures, including the left ureter.^[7]

Relationship with Surrounding Structures

• Left Ovarian Artery: The left ovarian vein runs parallel to the left ovarian artery, which provides oxygenated blood to the left ovary. Both the artery and vein follow the same general path from the pelvic cavity to the abdomen.
• Left Ureter: The left ovarian vein runs anterior to the left ureter. The ureter travels from the kidney to the bladder, and its proximity to the ovarian vein is important, especially during surgical procedures in the pelvic and abdominal areas. Surgeons must be mindful of this relationship to avoid damage to either structure.
• Left Renal Vein: One of the most critical anatomical relationships is between the left ovarian vein and the left renal vein. Unlike the right ovarian vein, which drains directly into the inferior vena cava (IVC), the left ovarian vein drains into the left renal vein. The point of drainage occurs at the level of the second lumbar vertebra (L2). From the left renal vein, the blood eventually reaches the IVC to be returned to the heart.
• Psoas Major Muscle: The left ovarian vein runs along the anterior surface of the psoas major muscle, which extends from the lumbar spine to the femur. This anatomical relationship is significant because the psoas muscle is a key landmark during retroperitoneal surgery.

Tributaries

The left ovarian vein may receive venous blood from several smaller tributaries as it ascends through the pelvis and abdominal cavity:

• Ovarian Venous Plexus: The primary tributary of the left ovarian vein is the ovarian venous plexus itself, which collects blood from the ovary, fallopian tube, and parts of the broad ligament.
• Uterine Venous Tributaries: Occasionally, small veins draining the upper portion of the uterus may contribute to the left ovarian vein, especially if the veins run within the broad ligament.^[7]
• Peritoneal Veins: Smaller veins from the peritoneum and surrounding tissues may also drain into the left ovarian vein, though these are usually minor tributaries.

Termination

The left ovarian vein terminates by draining into the left renal vein. The point of termination is located near the second lumbar vertebra (L2), just lateral to the left kidney. After joining the left renal vein, the blood flows into the inferior vena cava (IVC), which transports it to the heart for oxygenation. This termination pattern differs from the right ovarian vein, which drains directly into the IVC.

Variations

While the general anatomy of the left ovarian vein is consistent, some variations may occur. In certain individuals, the vein may have multiple smaller tributaries or duplicate branches that converge before reaching the left renal vein. Additionally, there may be anatomical variations in the size and course of the vein. Rarely, the left ovarian vein may exhibit connections to other nearby venous structures, or the point of drainage into the left renal vein may vary slightly in its position.

Function

The left ovarian vein plays a crucial role in draining deoxygenated blood from the left ovary and surrounding structures, facilitating the return of blood to the systemic circulation.^[5] Below is a detailed breakdown of the various functions of the left ovarian vein.

Venous Drainage of the Left Ovary

The primary function of the left ovarian vein is to drain deoxygenated blood from the left ovary. The ovary is a highly vascularized organ, receiving arterial blood from the left ovarian artery, which delivers oxygen and nutrients necessary for ovarian functions such as oogenesis (egg production) and hormone synthesis (e.g., estrogen and progesterone). After the exchange of gases and nutrients in the ovarian tissue, the deoxygenated blood is collected by the ovarian venous plexus, which converges to form the left ovarian vein. The vein ensures that the deoxygenated blood is efficiently transported away from the ovary, maintaining a proper balance of circulation and preventing blood pooling in the ovarian tissue.

Venous Drainage of the Left Fallopian Tube

In addition to draining the ovary, the left ovarian vein also collects blood from the left fallopian tube, which is responsible for transporting the ovum (egg) from the ovary to the uterus. The fallopian tube, like the ovary, receives oxygenated blood from the left ovarian artery, and the venous blood is then drained through small tributaries into the ovarian venous plexus. This ensures that the fallopian tube remains healthy and well-vascularized for normal reproductive function.

Venous Drainage of the Broad Ligament and Surrounding Structures

The left ovarian vein also plays a role in draining venous blood from parts of the broad ligament of the uterus, a double fold of peritoneum that supports the uterus, ovaries, and fallopian tubes.^[3] Small tributaries from the broad ligament, uterine veins, and surrounding connective tissue may drain into the left ovarian vein, helping to maintain proper blood flow through these structures. The efficient drainage of blood from the broad ligament and nearby tissues is essential for the overall health of the pelvic organs.

Transport of Deoxygenated Blood to the Left Renal Vein

One of the most important functions of the left ovarian vein is to transport deoxygenated blood from the ovarian venous plexus to the left renal vein. The left ovarian vein ascends from the pelvis and drains into the left renal vein near the left kidney. From there, the blood is carried through the left renal vein, which crosses the midline and empties into the inferior vena cava (IVC), ultimately returning to the heart for reoxygenation. The connection between the left ovarian vein and the left renal vein is a critical aspect of its function, ensuring that blood from the ovarian region is efficiently returned to the systemic circulation.

Prevention of Venous Congestion

The left ovarian vein plays a vital role in preventing venous congestion in the ovary and surrounding structures.^[2] Proper venous drainage ensures that blood does not accumulate or stagnate in the ovarian venous plexus. If the left ovarian vein is impaired or obstructed, increased venous pressure can lead to the dilation of veins and the formation of varices (enlarged veins), contributing to conditions such as pelvic congestion syndrome. By maintaining continuous and efficient blood flow, the left ovarian vein helps prevent venous insufficiency and promotes healthy circulation within the pelvis.

Collateral Circulation

The left ovarian vein can also participate in collateral circulation in cases where normal venous return is obstructed, such as due to compression or blockage of the left renal vein or inferior vena cava. In such cases, the left ovarian vein may provide an alternative pathway for blood to return to the heart by connecting to nearby venous structures. Although this is not the primary function of the left ovarian vein, its ability to support collateral circulation helps maintain venous return and prevents complications from impaired blood flow.

Regulation of Hormone Transport

As part of the circulatory system, the left ovarian vein helps in the transport of hormones produced by the ovary, such as estrogen and progesterone. These hormones are released into the bloodstream and carried by the venous system, including the left ovarian vein, toward the systemic circulation. Proper drainage of blood from the ovarian tissue ensures that these hormones are efficiently transported to target organs throughout the body, where they play a critical role in regulating the menstrual cycle, pregnancy, and overall reproductive health.

Clinical Significance

The left ovarian vein plays a critical role in several clinical conditions related to pelvic venous drainage:

Pelvic Congestion Syndrome

One of the most common clinical conditions involving the left ovarian vein is pelvic congestion syndrome (PCS). This condition occurs when the left ovarian vein becomes dilated and incompetent, leading to blood pooling in the pelvis. PCS is associated with chronic pelvic pain, especially in women, and is often caused by venous insufficiency or reflux within the ovarian vein. The increased venous pressure can cause varices and contribute to significant discomfort.

Varicosities

Dilation of the left ovarian vein can result in varicosities (varicose veins) in the pelvis. This condition is often observed in patients with PCS or in women who have had multiple pregnancies, which can increase pressure on the pelvic veins. Varicosities can affect not only the ovaries but also the uterus and lower extremities.

Surgical Considerations

The left ovarian vein's close relationship with the left renal vein and left ureter makes it an important anatomical structure during pelvic and abdominal surgeries. Careful management of the vein is necessary to prevent injury or complications such as excessive bleeding or venous damage.

Ovarian Vein Thrombosis

Though rare, ovarian vein thrombosis can occur in the left ovarian vein, especially postpartum or after pelvic surgery. This condition can cause abdominal pain, fever, and potential complications such as pulmonary embolism if the clot dislodges.