Gonadal vein

Last revised by Dr Yair Glick on 31 Aug 2021

The gonadal veins are paired structures that drain the gonads in males and females. In males it is called the testicular vein (or internal spermatic vein) and in females it is called the ovarian vein. The gonadal veins are paired with the gonadal arteries and ascend in the abdomen along the psoas muscle anterior to the ureters. Like the suprarenal veins, each side drains differently:

Ovarian veins emerge from the ovary as a plexus (pampiniform plexus) in the mesovarium and the suspensory ligament. Two veins emerge from the plexus and ascend with the ovarian artery, usually merging into a single vein before termination.

The right ovarian vein arises from the right pampiniform plexus (which is continuous with the uterine plexus). It ascends anterior to the psoas major muscle and lies right to the right ureter. It crosses the ureter anteromedially halfway between the bifurcation of the inferior vena cava (IVC) and the point where it joins the anterolateral IVC.

The left ovarian vein ascends similarly in the abdomen but drains into the left renal vein 1-4.

The venous circulation of the male gonads comprises two intrascrotal networks: a deep and a superficial venous network. The deep network drains the testis, epididymis, and ductus deferens. The superficial network drains the veins of the scrotum.

Veins of the testes and epididymis form the pampiniform plexus, which ascends to form four veins at the level of the superficial inguinal ring and a single testicular vein at the level of the deep inguinal ring. It ascends through the inguinal canal in the spermatic cord 3,4

The testicular vein ascends in the retroperitoneum on the psoas major muscle. Along its course there are variable communications with retroperitoneal veins, abdominal wall veins and renal capsular veins.

The right testicular vein usually drains into the inferior vena cava just below the renal vein, but sometimes drains into the right renal vein.

The left testicular vein invariably drains into the left renal vein.

  • duplication is common, more often on the left (~13%) than on the right (~2%) 7
  • both gonadal veins draining into the left renal vein
  • in inferior vena cava duplication, the left gonadal vein drains into the left inferior vena cava
  • partially divided gonadal veins, with the gonadal arteries running through
  • gonadal veins may receive a duodenal or suprarenal vein
  • gonadal veins draining into common iliac veins
  • right gonadal vein drains into the right renal vein 
  • may be in the form of a plexus 
  • the ovarian veins are frequently used to identify the ovaries; they are useful landmarks particularly for determining the origin of a pelvic mass
  • the ovarian vascular pedicle sign is present in 92% of ovarian masses 5: direct joining of an asymmetrically enlarged gonadal vein with a pelvic mass indicates that the ovary is the organ of origin 2,5
  • the ovarian vein is best visualized at level of the origin of the inferior mesenteric artery where it is surrounded by retroperitoneal fat and in the pelvis medial to external iliac vessels 2,5
  • the testicular vein normally measures 1-3 mm in diameter 8

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Cases and figures

  • Figure 1: pampiniform plexus
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  • Case 1: duplicated testicular vein
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  • Case 2: left ovarian vein drains into the IVC
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