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Abstract We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.
Resumo Este estudo apresenta dois casos de variação anatômica múltipla de vasos renais e gonadais. O primeiro caso apresentou uma duplicação da veia renal e a presença de uma artéria renal acessória. Porém, o fato mais interessante nesse caso foi a veia gonadal direita desembocar na veia renal direita inferior em vez de terminar na veia cava inferior, como seria o normal. No segundo caso, além de também encontrarmos uma artéria renal acessória, a veia gonadal direita desembocava no exato ponto de junção entre a veia renal direita e a veia cava inferior. Clínicos e cirurgiões devem estar familiarizados com a presença de possíveis variações dos vasos renais e gonadais, sendo um conhecimento imprescindível para obter um diagnóstico mais preciso e para evitar surpresas em procedimentos cirúrgicos abdominais.
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Resumen Objetivo: Establecer las posibles implicaciones clínicas y quirúrgicas asociadas a la presencia de arterias renales accesorias y su relación con desenlaces relevantes para la salud como la hipertensión arterial sistémica resistente y el rechazo agudo de trasplantes renales. Material y métodos: Revisión sistemática de la literatura registrada en International Prospective Register of Systematic Reviews. Cuatro autores cegados realizaron su búsqueda de 2008 a 2018, según criterios de inclusión, términos y combinaciones prestablecidos, en cinco bases de datos y gestor de referencias bibliográficas Zotero, evaluación de calidad con la herramienta Study Quality Assessment Tools, del National Heart, Lung, and Blood Institute y cálculo de índice Kappa. Resultados: 32 estudios seleccionados, superaron el mínimo de puntuación en la evaluación de la calidad metodológica, revelando bajo riesgo de sesgo. El grado de acuerdo entre los revisores, fue de 0.81-1.0, interpretado como concordancia, casi perfecta. Las características de los estudios, según el año de publicación fue considerable para los años 2013 y 2009. La mayoría de los estudios fueron realizados en Estados Unidos, seguido de otros países. Como desenlaces se encontraron seis estudios para Hipertensión arterial sistémica y 26 para Trasplante renal. Conclusiones: La presencia de arterias renales accesorias es una de las posibles causas a valorar en pacientes hipertensos con refractariedad al tratamiento convencional. Por su parte, la incidencia de rechazo y pérdida de viabilidad post trasplante renal se aproxima al 20% en pacientes con arterias renales accesorias y se asocia con complicaciones urológicas o sistémicas.
Abstract Objective: To establish some of the possible surgical and clinical implications related to the presence of accessory renal arteries and their relationship with relevant health outcomes like resistant systemic hypertension and acute rejection of renal transplantation. Methods: Systematic review of the literature registered in the International prospective register of systematic reviews. Four blinded authors carried out their search from 2008 to 2018, according to the inclusion criteria, pre-established terms, and combinations, in five databases and the Zotero bibliographic reference manager, quality assessment with the Study Quality Assessment Tools, from the National Heart, Lung, and Blood Institute, and calculation of Kappa indices. Results: 32 selected studies exceeded the minimum score in the assessment of methodological quality, revealing a low risk of bias. The degree of agreement between the reviewers was 0.81-1.0, interpreted as almost perfect concordance. The characteristics of the studies, according to the year of publication, were considerable for the years 2013 and 2009. Most of the studies were carried out in the United States, followed by other countries. Based on the outcomes, the following studies were found, six for systemic arterial hypertension and 26 for kidney transplantation. Conclusions: The presence of accessory renal arteries is one of the possible causes when assessing hypertension patients with refractoriness to conventional treatment. For its part, incidence of acute rejection and post-transplantation loss of viability are near 20% in patients treated with accessory renal arteries; it is associated with urological and systemic complications.
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In comparison with other organs, variants of blood supply to the kidneys were always at special attention due to end arteries. Anatomic variations in the renal vasculature are common and occurrence is varying in between 25% to 40%. The most common variation is presence of accessory renal arteries. Accessory renal artery generally diagnosed on abdomen angiography studies or cadaveric dissection. Only few studies or case report of intrauterine detection of accessory renal artery are available in printed and online literature. During a dedicated anomaly scan of 23 week foetus, detection of an accessory renal artery on left side entering kidney in inferior pole courses parallel to main renal arteries and arising from abdominal aorta. Knowledge of the possible anatomic variations and anomalies of the renal arteries like accessory renal arteries are necessary for proper surgical management during renal transplantation, abdominal aorta aneurysm repair, different urological procedures and angiographic procedures. As the various type of vascular and non - vascular interventions increase, knowledge of the different type of variations of the renal arteries is necessary for proper surgical management in the different specialties.
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Presence of supernumerary renal artery (accessory renal artery) is the most common anatomical variation of renal arterial systemand is seen with varying frequencies among different ethnic and racial groups. Prior knowledge of these variations is of great surgical importance as it influences the selection of donor kidney, partial nephrectomy and other urological procedures. Aim of the present study was to observe the prevalence of accessory renal artery (ARA) and their distribution pattern with relation to gender and side in adultNorth Indian population. One hundred normal healthy adult (16 males and 84 females; mean age of 43.5±10.42 years) who were prospective voluntary kidney donors underwent MDCTand CTangiography evaluation for the presence of accessory renal artery. Accessory renal artery (ARA) was present in 25.0% kidneys. The prevalence of accessory renal arteries in males and females was similar (25.0%) respectively. On the right side the prevalence of accessory renal artery was 26.0% and on left side it was 24.0%. In males 25% kidneys had unilateral single accessory renal artery. In females 14.3% of left kidneys and 16.7% of right kidneys had a single unilateral accessory renal artery. In 9.5% femalesubjects bilateral accessory renal arteries were present in the kidneys. The prevalence of accessory renal artery in our North Indian population was 25.0%, which is similar to studies from other Asian countries. The distribution pattern was not affected by gender and side. These findings need further validation in a larger cohort of subjects.
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Objective To investigate the management and clinical effect of accessory renal artery in living-related donor renal transplantation. Methods Clinical data of 277 donors and recipients undergoing living-related donor renal transplantation were retrospectively analyzed. According to the results of preoperative CT angiography (CTA), the donor kidney was selected and the accessory renal artery of the renal graft was treated intraoperatively. Intraoperative status of the donors, and intraoperative management, postoperative complications, clinical prognosis of the recipients were summarized. Results Among 277 cases of renal transplantation, accessory renal arteries were detected in 83 donors by preoperative CTA examination with an accuracy rate of 95%. Fifty-eight donor kidneys with accessory renal arteries were obtained. Twenty-five donor kidneys with accessory renal arteries were reconstructed and anastomized by vascular repairing. Among them, 1 patient presented with anastomotic thrombosis during abdominal closure, whereas the other 24 cases were successfully anastomized with excellent blood flow. No complications, such as hemorrhage, renal graft embolism, ureteral necrosis and urinary fistula, occurred after renal transplantation. The 1-year survival rates of the recipients and renal grafts were 94% and 91%. The clinical efficacy did not significantly differ between the recipients with single renal artery and their counterparts with accessory renal artery (P > 0.05). Conclusions It can be obtained good clinical efficacy of renal transplantation by selecting a suitable donor kidney and reconstructing and anastomizing the accessory renal artery of the renal graft through vascular repair.
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Background: A sound knowledge of variations of blood vessels is required during operative, diagnostic andendovascular procedures in the abdomen and pelvis. The anatomy of the gonadal vessels has assumed moreimportance with development of newer intra-abdominal operative and laparoscopic techniques. The main aimof this study is to highlight incidence of variable origin of gonadal artery and its clinical significance.Materials and Methods: Dissection of posterior abdominal wall was done in 30 cadavers in the department ofAnatomy, K.P.C. Medical College and Hospital, Kolkata to observe the origin and course of gonadal arteries.Results: Variation was found in two cases (6.67%). Both of the cases were in male (8.33%) and on the left side.Conclusion: Various morphological anomalies of gonadal arteries are reported. The possible embryologicalbasis for this variation as well as its clinical significance, are discussed. The knowledge of this variation willhelp the radiologists and surgeons in avoiding clinical complications during uroradiologic interventions andsurgical procedures such as renal and gonadal surgeries.
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Variations in the origin of the branches from abdominal aorta are seen frequently. During a routine cadavericdissection it was seen kidney is receiving an accessory artery which originated from the lateral side of aortabelow the inferior mesenteric artery. It is accompanied by the renal vein. These variations are important duringthe Renal surgeries and any therapeutic procedures of the abdominal aorta
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Objective To explore the relationship between accessory renal artery(ARA)and essential hypertension,and the possible mechanism using CT angiography(CTA).Methods The patients who underwent CTA examination on renal artery were reviewed retrospectively in our hospital.A variety of CTA reconstruction techniques were used to observe the type and number of ARA,as well as the diameter of ARA and the main renal artery.Results A total of 126 ARA(66 left ARA and 60 right ARA)were found in 253 patients. 10% of the patients had more than two ARAs.In 164 patients with essential hypertension,ARA detection rate was 40.2%(66/164).In the non-hypertension patients,the proportion of ARA was 31.5%(28/89).There was higher proportion of young(P=0.002)and male (P=0.022)patients in ARA hypertension group compared with ARA non-hypertension group.There were no significant differences on the prevalence of type(P=0.826)and number of ARA(P=0.501)between these two groups.In all of the patients with single ARA,no significant differences were detected on the ratios of diameter of ARA and main renal artery between the two groups(P=0.32). However,in ARA hypertension group,the diameter of main renal artery on the ARA side was significantly smaller than that on the opposite side(P=0.01).In non-hypertension ARA group,no statistical difference was found between the diameter of bilateral main renal arteries(P=0.06).Conclusion ARA is more prevalent in essential hypertensive patients,especially in young male.The decrease of the diameter of main renal artery in the ARA side may be a possible mechanism for essential hypertension.
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Objective To evaluate the clinical application value of CT angiography(CTA) in detection of the accessory renal artery(ARA).Methods The renal artery CTA in 100 cases was reconstructed retrospectively with volume rendering (VR), multiplanar reconstruction (MPR), maximum density projection (MIP) and curved surface reconstruction (CPR).Results In all 200 kidneys,ARA were 47 with an incidence of 23.5% (47/200).The incidence of ARA in male and female were about 17% and 13%, and there was no significant difference between them.The ARA in the upper pole of the kidney was 25 (53.1%), and in lower pole was 22 (46.9%).It was showed on MIP with a display rate of 100%, on MRP of 93.6%, on VR of 90.4% and on CPR of 85.1%.Conclusion CTA is a safe, rapid, noninvasive and economical method for the diagnosis of ARA.It is helpful for surgical renal operation, interventional therapy and renal transplantation.
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Renal blood supply presents a large degree of variations. In the present case there was existence of bilateral variations in renal blood supply along with right sided bifid ureter. During routine cadaveric dissection in a middle aged male cadaver we found two renal veins draining right kidney and a bifurcating single renal vein on left side. On both sides one polar artery arising from main renal artery going to upper pole of kidney and left side accessory renal artery originating from abdominal aorta and giving origin to left testicular artery were observed. There is bifid ureter on the right side. The knowledge of renal vascular anatomy and its variations are very much essential in case of renal transplantation, renal surgeries, uroradiology, gonadal color Doppler imaging, in abdominal aortic aneurysmal and gonadal surgeries.
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Background: Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renovascular hypertension, renal artery embolization, angioplasty. The anomalies of accessory renal artery may be important from the clinical point of view. The importance of being familiar with the renal artery and segmental artery variability, which has become indispensable to urological surgery, has increased as a result of the large number of renal transplants and vascular reconstructions. Materials and Methods: 100 kidneys (Fifty pairs) intact with abdominal aorta were collected from department of Forensic department, JSS Medical College and Mysore Medical College. For study of segmental variation Corrosion cast technique method was used. The variations of posterior division were observed and recorded. Results: Accessory renal arteries were found in two specimens originating directly from aorta out of 100 specimens, it is recorded as 2%. Conclusion: In present study we observed 2% of cases as accessory renal artery. The recent days the increasing demand for kidney transplantation, grafts from living donor is major source for that, with this concept the knowledge of accessory renal artery very essential for kidney transplantation.
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Variations in renal arteries are common due its complicated development, ascent and rotation. Estachius first described a case of multiple renal arteries in 1552. These arteries frequent at the inferior pole rather than the superior pole of kidneys. Additional renal arteries may or may not be associated with the congenital malformations of the kidneys. We report a unique asymmetrical bilateral variation of renal artery with right sided early division and left sided accessory/ additional arteries. It is not associated with any other anomaly of kidneys. All of these branches entered the kidney through the hilum. This observation has clinical relevance for surgery, imaging, interventional radiological procedures as well as other diseases of kidney. Since renal arteries are end arteries; early branches and multiple arteries need to be attended individually during renal transplantation surgeries for better outcome.
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Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, surgery for abdominal aortic aneurysm and conservative or radical renal surgery.
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A precise knowledge of the vascular variations of human kidney is essential for the surgeon and radiologist to avoid complication during interventional radiological procedure, renal transplantation, renal trauma and other urological procedures. The present case report is regarding unilateral variation of renal vein and bilateral variation of renal artery. During routine cadaveric dissection of abdominal region, we observed three renal veins in right kidney. All right renal veins were emerging from hilum of kidney and drained in inferior vena cava where as in left Kidney venous drainage is normal. In right Kidney both main and accessory renal artery arose from abdominal aorta. Left main renal artery arose from abdominal aorta with left accessory renal artery arising from left middle suprarenal artery which is branch of coeliac trunk. In this case right ureteropelvic junction is seen to be compressed in between right accessory renal artery and right lower renal vein which crossed anteriorly with right middle renal vein crossing posteriorly this condition may cause hydronephrosis. The above finding to be reported in a single case is rarely seen. This is a valuable contribution from anatomical knowledge to operative procedures.
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Knowledge of the existence of the aberrant renal arteries is important because they may be inadvertently damaged during renal surgery and their presence must be considered in evaluating a donor kidney for possible renal transplantation. Using conventional dissecting techniques, the posterior abdominal wall was dissected in a 45years old embalmed male cadaver in the gross anatomy dissecting laboratory of college of health Sciences Ayder Campus Mekelle University Ethiopia. Following the fine dissection, we noticed an aberrant right renal artery (accessory renal artery) originated from the abdominal aorta at the level of L3 vertebra, besides the normal renal artery that arises high up at the level of L1, L2. This accessory renal artery does not have a parallel course with the normal renal artery, it course upward and laterally to the inferior pole of the right kidney which it pierces, However there was no such observation on the left
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Origin of the Testicular Artery variations were found during routine dissection of abdomen of the middle aged cadaver in the Dept of Anatomy, Govt. Medical College Jammu. On the left side there were two renal arteries, One of them was the main Renal artery which was originating from the anterolateral aspect of abdominal aorta and running to the hilum of the kidney in front of the renal vein The other was the Accessory Renal artery which was originating from anterolateral aspect of aorta 5mm above origin of main renal artery and going to the upper pole of the kidney. The origin of accessory renal artery and main renal artery was 4.2 and 9.2mm below the level of origin of superior mesentric artery. The left testicular artery was originating from the accessory renal artery and crossing the renal artery and the renal vein anteriorly before following its usual course in the posterior abdominal wall. Only one renal artery was seen on the right side arising from the anterolateral aspect of aorta. The right testicular artery originated 52mm below the origin of right renal artery and followed its normal course This anomaly is explained by embryological development of both kidneys and gonads from intermediate mesoderm of mesonephric crest. Further the vasculature of kidneys and gonads is derived from lateral mesonephric branches of dorsal aorta .Even though the condition presents as a silent renal anomaly (Undiagnosed throughout life and revealed only on autopsy) the surgical implications are noteworthy, which too have been highlighted in this report.
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The variation in origin of the testicular artery is not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. The renal artery is known to exhibit variations in its number and position. The knowledge of this variation will help the radiologists and surgeons in avoiding clinical complication during interventions. During routine dissection teaching to first year MBBS students at Sapthagiri Medical College, Bangalore we found variation in vascular pattern of testicular and renal artery associated with renal cyst. Photographs of the variations were taken. There was high origin of left testicular artery and accessory left renal artery associated with bilateral simple renal cyst in adult Male cadaver aged around 60years.There was also prehilar division of right renal artery associated with renal cyst. Anomalies in the origin, course and number of testicular artery were observed in 4.7 percent of cases. Additional renal vessels are known as the accessory renal artery and their incidence varies between 9-76%. In the present case there was high origin of left testicular artery associated with accessory renal artery and renal cyst. This anatomical knowledge of the presence of accessory renal artery and high origin of testicular artery in this case is important for radiologists, surgeons and urologist in their clinical practice.
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During routine dissection of a 42 year old male Indian cadaver posterior abdominal wall, variations in the testicular vessels were observed. The right testicular artery arose from the right accessory renal artery, which originated from the ventral aspect of the abdominal aorta. The left testicular artery originated from the ventral aspect of the aorta in almost the same horizontal line as the right accessory renal artery, just below the superior mesenteric artery and 1.79 cm, above the origin of the renal arteries. The right vein drained into the right accessory renal vein instead of the inferior vena cava, while the left testicular vein drained into the left renal vein. The presence of variation of both the testicular arteries as well as the testicular vein is seldom seen together.
Durante una disección de rutina de un cadáver, perteneciente a un hombre indio de 42 años, se observaron variaciones en los vasos testiculares en la pared abdominal posterior. La arteria testicular derecha se originó desde la arteria renal accesoria, proveniente de la cara ventral de la parte abdominal de la aorta. La arteria testicular izquierda se originó en la cara ventral de la parte abdominal de la aorta, casi en la misma línea horizontal de la arteria renal accesoria derecha, justo distal a la arteria mesentérica superior y 1,79 cm sobre el origen de las arterias renales. La vena renal derecha drenaba en la vena renal accesoria en lugar de la vena cava inferior, mientras que la vena testicular izquierda drenaba en la vena renal izquierda. En muy pocas ocasiones es posible observar de manera conjunta, variaciones tanto de las arterias como de las venas testiculares.
Subject(s)
Humans , Male , Adult , Renal Artery/anatomy & histology , Renal Veins/anatomy & histology , Testis/blood supply , Anatomic Variation , Aorta, Abdominal , Cadaver , Dissection , Kidney/blood supplyABSTRACT
Horseshoe kidney is a common renal anomalies, but coexistence with abdominal aortic aneurysm (AAA) is rare. Horseshoe kidney may cause various technical difficulties of aneurysm repair. A 76-year-old man was referred to our hospital for treatment of AAA with a horseshoe kidney. Preoperative 3-dimensional computed tomography (3D-CT) scans showed a pair of normal renal arteries and 3 accessory renal arteries from the anterior wall to abdominal aorta just proximal to an aneurysm. At operation, the aneurysm was exposed through a transperitoneal approach, and artificial graft replacement was performed with a woven Dacron bifurcated graft preserving the renal isthmus. The accessory renal arteries were not reconstructed. The postoperative course was uneventful. Postoperative 3-D CT showed minor infarction of renal isthmus, but renal function was not impaired.
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A case of variations in the ventral and lateral and dorsal branches of abdominal aorta were observed in a 50-year-old male cadaver during routine dissection for medical undergraduate students. The common hepatic artery was arising directly from abdominal aorta. Right inferior phrenic artery originated directly from the abdominal aorta along with upper right renal artery about 0.4cm below the origin of superior mesenteric artery. Triple renal arteries were seen on the right side, all arising from abdominal aorta whereas on the left side, a single renal artery was seen entering the kidney. The upper right renal artery was present behind the inferior vena cava whereas the middle and inferior right renal arteries were present in front of the inferior vena cava. On the right side, ureter was placed anterior to renal vessels. Knowledge of the above variations in the branches of abdominal aorta have clinical importance not only for surgeons but also for interventional radiologists.