Pedículo Renal: Análisis de sus Variantes / Renal Pedicle: Analysis of their Variants

Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describen las relaciones intrínsecas del pedículo renal (PR) a partir de dos planos coronales, siendo la PER el elemento que limita entre ambos. Trivedi et al. (2011) demostró relaciones entre los elementos del PR que no coinciden con las descripciones aportadas por dichos autores.Conocer las posibles variantes en las relaciones intrínsecas del PR es de suma importancia en prácticas quirúrgicas como el trasplante renal (García de Jalón Martínez et al., 2003; Batista Hernández et al., 2010). Por lo tanto, el objetivo del presente trabajo fue analizar las variables relaciones entre los elementos que conforman el PR en la región yuxtahiliar del riñón. Se estudiaron 23 PR, formolizados al 10 % y provistos por el Equipo de Disección de la Segunda Cátedra de Anatomía de la Universidad de Buenos Aires. Se clasificaron los PR en dos grupos. En el Grupo I, las afluentes de origen de la vena renal (AOVR) se hallaban en el mismo plano coronal. En el grupo II, las AOVR se encontraban en diferentes planos coronales. Cada grupo fue subdividido en distintos patrones. Los patrones I y II, de mayor incidencia, fueron asociados al grupo I y los patrones III, IV y V al grupo II. En el patrón I, las AOVR eran anteriores a la pelvis renal (PER) y posteriores a la arteria prepiélica (APP). En el patrón II, las AOVR eran anteriores a la PER y a la APP. Los patrones I y II conforman el grupo I y presentaron mayor número de incidencia en nuestra investigación. Existen también variantes que inciden con menor frecuencia que dichos patrones, estas comprenden el grupo II de la clasificación planteada en el presente trabajo.

SUMMARY: Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describe the intrinsic relationships of the renal pedicle (PR) from two coronal planes, the renal pelvis (PER) being the element that limits between both. Trivedi et al. (2011) showed relationships between the elements of the RP that do not coincide with the descriptions provided by these authors. Knowing the possible variants in the intrinsic relationships of the RP is of the utmost importance in surgical practices such as renal transplantation (García de Jalón Martínez et al., 2003). Therefore, the objective of this study is to analyze the variable relationships between the elements that make up the RP in the juxtahilar region of the kidney. 23 RP were studied, formalized at 10 % and provided by the Dissection Team of the Second Chair of Anatomy of the University of Buenos Aires. PRs were classified into two groups. In Group I, the tributaries of origin of the renal vein (RVOA) were in the same coronal plane. In group II, the AOVRs were in different coronal planes. Each group was subdivided into different patterns. Patterns I and II, with the highest incidence, were associated with group I and patterns III, IV and V with group II. In pattern I, the VROA were anterior to the renal pelvis (PER) and posterior to the prepelvic artery (PPA). In pattern II, AOVRs were prior to PER and APP. Patterns I and II make up group I and presented a higher number of incidence in our investigation. There are also variants that occur less frequently than these patterns, these comprise group II of the classification proposed in this work.

Artéria renal tripla em porco-espinho (Sphiggurus villosus): relato de caso / Triple renal artery in porcupine (Sphiggurus villosus): case report

O interesse pelo estudo de animais silvestres vem crescendo consideravelmente nos últimos anos, seja em decorrência do riscode extinção ou visando o controle de doenças, especialmente as zoonoses. A ordem Rodentia apresenta o maior número deespécies da classe Mammalia. Apesar de ampla distribuição e importância, dados sobre sua anatomia vascular renal são escassosna literatura. O objetivo deste artigo é relatar o aparecimento de variação numérica na artéria renal esquerda em Sphiggurusvillosus com enfoque nas possibilidades de implicações clínico-cirúrgicas, como, anastomoses cirúrgicas, estudos imaginológicos,nefrectomias e planejamento pré-operatório para redução de riscos e complicações como hemorragia. O cadáver foi devidamenteformolizado no Laboratório de Ensino e Pesquisa em Morfologia de Animais Domésticos e Selvagens e posteriormente dissecado.O rim esquerdo apresentou três artérias renais, uma cranial, uma intermediaria e outra caudal, ambas posicionadas em nível de L2emergindo de forma impar lateralmente da aorta abdominal. A primeira artéria, mais cranial, apresentou 10,52 mm de comprimentoe se dirigiu diretamente para o hilo renal, emitindo ramo para adrenal, diafragma e musculatura sublombar. A segunda artéria,intermediária, mediu 7,77 mm, emitiu ramo cranial e caudal para o hilo renal e ramo ureteral. A terceira artéria, caudal, mediu10,11 mm e se dirigiu para o hilo renal. A veia renal esquerda era única e apresentou 9,25 mm de comprimento, posicionada emnível de L1. Este é o primeiro relato de artéria renal tripla em mamífero silvestre.

Interest in the study of wild animals has grown considerably in recent years, either due to the risk of extinction or to control diseases,especially zoonoses. The order Rodentia has the largest number of species in the Mammalia class. Despite its wide distributionand importance, data on its renal vascular anatomy are scarce in the literature. The aim of this paper is to report the appearanceof numerical variation in the left renal artery in porcupine focusing on the possibilities of clinical and surgical implications, suchas surgical anastomoses, imaging studies, nephrectomies and preoperative planning to reduce risks and complications such asbleeding. The animal was duly formalized in the Laboratory of Teaching and Research in Morphology of Domestic and Wild Animalsand subsequently dissected. The left kidney had three renal arteries, one cranial, one intermediate, and one caudal, both positionedat L2 level, emerging unevenly laterally from the abdominal aorta. The first more cranial artery was 10.52 mm long and directeddirectly into the renal hilum, emitting a branch to the adrenal, diaphragm and sub lumbar muscles. The second intermediate arterymeasured 7.77 mm, emitting a cranial and caudal branch to the renal hilum and ureteral branch. The third caudal artery measured10.11 mm and headed straight for the renal hilum. The left renal vein was unique, measured 9.25 mm long, and positioned at L1level. This is the first report of triple renal artery in wild mammals.

Artéria renal tripla em porco-espinho (Sphiggurus villosus): relato de caso / Triple renal artery in porcupine (Sphiggurus villosus): case report

O interesse pelo estudo de animais silvestres vem crescendo consideravelmente nos últimos anos, seja em decorrência do risco de extinção ou visando o controle de doenças, especialmente as zoonoses. A ordem Rodentia apresenta o maior número de espécies da classe Mammalia. Apesar de ampla distribuição e importância, dados sobre sua anatomia vascular renal são escassos na literatura. O objetivo deste artigo é relatar o aparecimento de variação numérica na artéria renal esquerda em Sphiggurusvillosus com enfoque nas possibilidades de implicações clínico-cirúrgicas, como, anastomoses cirúrgicas, estudos imaginológicos, nefrectomias e planejamento pré-operatório para redução de riscos e complicações como hemorragia. O cadáver foi devidamente formolizado no Laboratório de Ensino e Pesquisa em Morfologia de Animais Domésticos e Selvagens e posteriormente dissecado. O rim esquerdo apresentou três artérias renais, uma cranial, uma intermediaria e outra caudal, ambas posicionadas em nível de L2 emergindo de forma impar lateralmente da aorta abdominal. A primeira artéria, mais cranial, apresentou 10,52 mm de comprimento e se dirigiu diretamente para o hilo renal, emitindo ramo para adrenal, diafragma e musculatura sublombar. A segunda artéria, intermediária, mediu 7,77 mm, emitiu ramo cranial e caudal para o hilo renal e ramo ureteral. A terceira artéria, caudal, mediu 10,11 mm e se dirigiu para o hilo renal. A veia renal esquerda era única e apresentou 9,25 mm de comprimento, posicionada em nível de L1. Este é o primeiro relato de artéria renal tripla em mamífero silvestre.

Interest in the study of wild animals has grown considerably in recent years, either due to the risk of extinction or to control diseases, especially zoonoses. The order Rodentia has the largest number of species in the Mammalia class. Despite its wide distribution and importance, data on its renal vascular anatomy are scarce in the literature. The aim of this paper is to report the appearance of numerical variation in the left renal artery in porcupine focusing on the possibilities of clinical and surgical implications, such as surgical anastomoses, imaging studies, nephrectomies and preoperative planning to reduce risks and complications such as bleeding. The animal was duly formalized in the Laboratory of Teaching and Research in Morphology of Domestic and Wild Animals and subsequently dissected. The left kidney had three renal arteries, one cranial, one intermediate, and one caudal, both positioned at L2 level, emerging unevenly laterally from the abdominal aorta. The first more cranial artery was 10.52 mm long and directed directly into the renal hilum, emitting a branch to the adrenal, diaphragm and sub lumbar muscles. The second intermediate artery measured 7.77 mm, emitting a cranial and caudal branch to the renal hilum and ureteral branch. The third caudal artery measured 10.11 mm and headed straight for the renal hilum. The left renal vein was unique, measured 9.25 mm long, and positioned at L1 level. This is the first report of triple renal artery in wild mammals.

Renal artery in tufted capuchin monkey: structure and morphometry / Artéria renal do macaco prego: estrutura e morfometria

The objective was to describe the structure of the renal artery in capuchin monkey at the level of the proximal and distal arterial segments. Morphometric analysis was performed referring to the thickness and quantification of tissue elements of the renal artery tunica media in both segments. Renal arteries of eight adult capuchin monkeys were collected for histological analysis of the two segments, being the proximal part branched from the abdominal aorta, and the distal part localized next to the renal hilus. The quantification of smooth muscle cells and connective elements was carried out in transversal sections of the two segments; for the tunica media, it was used the volume densities of smooth muscle cells, collagen and elastic fibers. Considering these volume densities obtained for each segment, it was verified that the proximal segment showed a marked myoconnective architecture, while the distal segment was characterized by a single muscular artery. Apparently, the mixed architecture of the proximal segment could be related to a blood flow control at the aortic emergence of the renal artery, which helped to guarantee a priority flow of enriched plasma into the kidney parenchyma.

O objetivo foi descrever a estrutura da artéria renal no macaco prego ao nível dos segmentos arteriais proximal e distal. Uma análise morfométrica foi realizada, tendo como parâmetros a espessura e a quantificação dos elementos constituintes da túnica média da parede vascular, nos dois segmentos. Foram coletadas as artérias renais de oito macacos pregos adultos para estudos histológicos dos dois segmentos, sendo o segmento proximal a parte originária da aorta abdominal e o segmento distal a parte arterial junto ao hilo renal. A quantificação de células musculares lisas e de elementos conjuntivos da matriz extracelular foi realizada em secções transversais dos dois segmentos, sendo empregadas para a túnica média as densidades de volumes (DV), dos componentes musculares e das fibras elásticas e colágenas. Tendo por base estas densidades de volumes obtidas para cada segmento arterial verificou-se que o segmento proximal apresentou estrutura mioconjuntiva marcante, enquanto que o segmento distal foi caracterizado como uma artéria muscular padrão. Aparentemente, a arquitetura mista do segmento proximal estaria relacionada com o controle de fluxo sanguíneo na emergência aórtica da artéria renal, garantindo um direcionamento prioritário de fluxo de plasma sanguíneo enriquecido para dentro do parênquima renal.

Resultados del trasplante renal con donante vivo: análisis comparativo entre arteria renal única y múltiple / Outcome in Living Donor Kidney Transplant: Comparative Análisis of Single and Multiple Renal Arteries

Objetivos: Realizar un análisis comparativo de los resultados funcionales y complicaciones en trasplantados renales y sus respectivos donantes vivos con arteria renal única versus múltiple. Materiales y métodos: Trabajo retrospectivo analítico de una base de datos confeccionada prospectivamente de pacientes sometidos a trasplantes renales con donante vivo en nuestra institución entre mayo de 2010 y julio de 2014. Según el número de arterias presentes en la angiotomografía preoperatoria se confeccionaron dos grupos: grupo 1 (arteria renal única) y grupo 2 (arteria renal múltiple). Resultados: De los 91 pacientes incluidos, el 37% (n=34) presentaba arterias renales múltiples. Se realizó una nefrectomía laparoscópica al 63% (n=36) y el 41% (n=14) de los donantes del grupo 1 y el grupo 2, respectivamente (p=0,05). Tiempos promedio de isquemia total (grupo 1: 55,6 min; grupo 2: 56 min; p=0,931), de anastomosis (grupo 1: 29,6 min; grupo 2: 29,7 min; p=0,982) y de "cirugía de banco" (grupo 1: 23,5 min; grupo 2: 23,8 min; p=0,948). Transfusión de glóbulos rojos en los receptores (grupo 1: 7%; grupo 2: 14%; p=0,23). Porcentaje de hemodiálisis en la primera semana (grupo 1: 5,2%; grupo 2: 5,8%; p=1). No se hallaron diferencias significativas entre grupos a nivel de tasa de complicaciones y días de internación. Ambos grupos presentaron una sobrevida del injerto del 100% a los 35,6 meses de seguimiento promedio. Conclusiones: La presencia de multiplicidad arterial no debe ser considerada una contraindicación para el donante vivo, ya que el implante de estos injertos logra resultados funcionales similares a los injertos renales con arteria única, sin aumentar la morbilidad del procedimiento. (AU)

Objectives: TTo compare functional outcomes and complications in patients with a single artery versus multiple arteries undergoing living donor nephrectomy. Materials and methods: Retrospective analysis of a prospective collected database of living donor kidney transplantations performed at our institution between May 2010 and July 2014. According to the number of arteries present in preoperative angiotomography, two groups of patients were organized: group 1 (single artery) and group 2 (multiple arteries). Results: TNinety-one living donor kidney transplantations were performed during this period. A total of 34 patients (37%) had multiple renal arteries. Mean total ischemia time (single: 55.6 min; multiple: 56 min; p=0.931), anastomosis time (single: 29.6 min; multiple: 29.7 min; p=0.982), bench surgery time (single: 23.5 min; multiple: 23.8 min; p=0.948). Blood transfusion rate was 7% and 14% for group 1 and group 2, respectively (p=0.23). Three patients in group 1 (5.2%) and two patients in group 2 (5.8%) needed dialysis during the first postoperative week (p=1). Overall, recipient complication rate and hospital stay were similar between group 1 and 2. Both groups had a 100% graft survival with a mean follow-up of 35.6 months. Conclusions: The presence of multiple renal arteries should not be considered a contraindication for the living donor nephrectomy, since these grafts achieve similar functional results to single artery renal grafts, without increasing the morbidity of the procedure. (AU)

Dupla variação anatômica vascular em um único indivíduo: estudo morfométrico / Dual vascular anatomical variation in a single individual: morphometric study

INTRODUÇÃO: Variações anatômicas são pequenas diferenças morfológicas congênitas que aparecem nos diferentes sistemas orgânicos, as quais não acarretam prejuízo ou distúrbio funcional para o indivíduo. No que diz respeito aos vasos sanguíneos, alterações no desenvolvimento embriológico podem gerar duplicidade de vasos, agenesia ou ocasionar o surgimento de artérias e o desembocar de veias fora da descrição anatômica padrão. RELATO DE CASO: Foi observada dupla variação anatômica vascular em um indivíduo durante uma dissecação de rotina no Laboratório de Anatomia do Centro Universitário São Camilo. A artéria renal principal tinha origem na parte abdominal da artéria aorta seguindo até sua entrada no hilo renal, porém, em vez de um trajeto retilíneo a partir da aorta, a mesma possuía um trajeto descendente e bem angulado. A partir da artéria renal principal surgia uma artéria polar aberrante que entrava no polo inferior do rim direito. Em um nível mais inferior, na altura da bifurcação da aorta, originava-se outra artéria polar aberrante que entrava no hilo renal, seguindo um trajeto retilíneo até o polo inferior do rim direito. A artéria hepática comum originava-se no tronco celíaco seguindo até sua entrada na porta do fígado. A artéria mesentérica superior possuía origem no tronco celíaco. A artéria hepática direita originava-se na artéria mesentérica superior. CONCLUSÃO: O estudo das variações anatômicas constitui-se tarefa árdua em virtude das inúmeras expressões diferentes que ocorrem no corpo humano, porém, o conhecimento dessas variações é de extrema valia para a clínica e o planejamento cirúrgico, garantindo a precisão e evitando complicações pós-cirúrgicas ou diagnósticos errôneos.

INTRODUCTION: Anatomical variations are small congenital morphological differences that appear in different organ systems, which do not result in damage or functional disturbance for the individual. When it comes to blood vessels, alterations in embryological development may lead to the duplicity and the agenesis of vessels, or cause the emergence of arteries and the disembogue of vessels not according to the standard anatomical description. CASE REPORT: Dual anatomical variation in an individual was observed during a routine dissection in the Laboratory of Anatomy of the Centro Universitário São Camilo. The main renal artery originated in the abdominal part of the aorta artery, following its path until its entry in the renal hilum. However, instead of a rectilinear path from the aorta, it had a descending and well-angulated path. From the main renal artery, an aberrant polar artery emerged, that entered the inferior pole of the right kidney. At a lower level, on the same level as the bifurcation of the aorta, another aberrant polar artery emerged, which entered the renal hilum following a straight path to the inferior pole of the right kidney. The common hepatic artery was originated in the celiac trunk, following its path until its entrance in the porta hepatis. The superior mesenteric artery was originated in the celiac trunk. The right hepatic artery was originated in the superior mesenteric artery. CONCLUSION: The study of anatomical variations is an arduous task due to the innumerable different expressions that occur in the human body. However, the knowledge of these variations is extremely valuable for medicine and surgical planning,assuring accuracy and avoiding postoperative complications or erroneous diagnoses.

Morphological characterization of the renal arteries in the pig: comparative analysis with the human / Caracterización morfológica de las arterias renales en el cerdo: análisis comparativo con el humano

In spite of its importance as an experimental model, information on therenal artery inpigs is scarce.The objective of this work was to determine the morphological characteristics of the renal artery (RA) and its branches in pigs. One hundred and twenty one (121) pairs of kidneys of pigs destined to slaughter by stunning were studied. The RA and its branches were perfused with polyester resin (Palatal 85 % t Styrene 15 %)and subjected to KOH infusion (potassium hydroxide) for total corrosion. Calibers were measured, and trajectories and relations with adjacent arterial structures were evaluated.Continuous variables were assessed with Student's t test,and discrete variables with Pearson's chi square test. The significance level used was p<0.05. The origin of the RA was symmetric in 57 specimens (50.4 %), with the right renal arterybeing more cranial in 55 % of the cases. Single renal arteries were seen in 98.4 %, without significant side differences (p=0.31).The caliber and length of the RA were 5.11mm (SD1.35) and 30.1mm (SD8.63), respectively. A pattern of RA expression that causes one cranial and one caudal polar branch (Type I) was observed in 97.1 % of the cases. The distribution of the RA in cranial and caudal polar branches was found to be higher than what is described in the literature, since these morphometric features have not been reported in prior studies.These findings contribute to a better knowledge in the field of the compared anatomy of the kidney, and allow for applying the pig model in procedural and hemodynamic applications.

A pesar de su importancia como un modelo experimental, la información sobre la arteria renal en los porcinos es escasa. El objetivo de este trabajo fue determinar las características morfológicas de la arteria renal (AR) y sus ramas en cerdos. Fueron estudiados 121 pares de riñones de cerdos destinados al sacrificio con método de aturdimiento. Las AR y sus ramas fueron perfundidas con resina poliéster (Palatal 85 % t Estireno 15 %) y sometidas a infusión de KOH (hidróxido de potasio) para corrosión total. Se midieron calibres, evaluaron trayectorias y relaciones con estructuras arteriales adyacentes. Se evaluó las variables continuas con el test de t student y las variables discretas con el test de chi cuadrado de Pearson. El nivel de significancia usado fue de p<0,05. El origen de la AR fue simétrico en 57 muestras (50,4 %), siendo la arteria renal derecha la más craneal en el 55 % de los casos. Se observó arterias renales únicas en el 98,4 %, sin diferencias significativas de lado (p=0,31). El calibre y la longitud de la AR fue 5,11 mm (SD 1,35) y 30,1 mm (SD 8,63) respectivamente. En el 97,1 % se observó un patrón de expresión de la AR que origina una rama polar craneal y una caudal (Tipo I). La distribución en ramas polares craneal y caudal de la AR es superior a lo descrito en la literatura, en tanto que las características morfométricas no han sido reportadas en estudios previos. Estos hallazgos contribuyen al mejor conocimiento en el campo de la anatomía comparada del riñón y permiten postular al modelo porcino en aplicaciones procedimentales y hemodinámicas.

A cadaveric study of the testicular artery and its clinical significance / Um estudo da artéria testicular em cadáveres e sua relevância clínica

Abstract Background Knowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy. Objectives The present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins. Methods This study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured. Results Testicular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication. Conclusion This study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.

Resumo Contexto O conhecimento de variações da artéria testicular é vital para assegurar que essas artérias não serão negligenciadas durante a realização de diferentes técnicas operatórias, já que qualquer dano poderia causar atrofia testicular. Objetivos Este estudo teve como objetivo identificar variações na origem e no trajeto das artérias testiculares. Foi feita uma tentativa de classificar as artérias com base em suas diferentes origens. Métodos Este estudo examinou 42 cadáveres de adultos do sexo masculino com idade entre 40 e 70 anos preservados em formol. As diferentes origens da artéria testicular foram identificadas e classificadas. Variações na origem e no trajeto da artérias foram coloridas, fotografadas e documentadas. Foram medidas as distâncias entre a origem das artérias testiculares e o ponto médio da origem das artérias renais. Resultados As artérias testiculares foram classificadas em quatro categorias com base em sua origem. Essa variabilidade foi definida com relação às artérias renal e mesentérica inferior. A distância média entre a origem da artéria testicular e o ponto médio da origem da artéria renal foi de 3,08 e 3,47 cm nos lados direito e esquerdo, respectivamente. As variações foram encontradas quase exclusivamente no lado esquerdo. As variações observadas incluíram múltiplos ramúsculos formando a artéria testicular, artérias suprarrenais surgindo a partir da artéria testicular, e duplicação da artéria testicular. Conclusão Este estudo traz informações sobre variações da artéria testicular e propõe uma classificação que poderia ajudar os cirurgiões durante diferentes procedimentos realizados no abdome e na pelve de pacientes do sexo masculino.

Anatomía del segmento prehiliar de la arteria renal en caninos / Anatomy of prehiliar segment of the renal artery in dogs

La literatura anatómica describe, en general, que el riñón canino está irrigado por una arteria renal única. Estudios de campo han demostrado la existencia de variaciones anatómicas en el segmento prehiliar. Esta especie es utilizada como modelo urológico durante el entrenamiento quirúrgico por su fácil obtención, manipulación y tamaño. Estudios han descrito el patrón arterial intra-renal, sin embargo, la anatomía del segmento pre-hiliar de la arteria renal ha sido poco investigada. El objetivo del presente estudio fue describir el patrón arterial renal en el segmento pre-hiliar en caninos. Treinta pares de riñones de caninos fueron disectados y evaluados de acuerdo a 1) número de ramas por arterias renales únicas, 2) altura de origen de las arterias renales, 3) patrones de arteria renal doble y 4) lugar de bifurcación prehiliar de la arteria renal única. La aorta abdominal fue repletada con látex natural y posteriormente se disecó. Se observó arteria renal única y doble en el 90% y 10% de los casos, respectivamente. El número de ramas de la arteria renal única fue dos, tres y cuatro en el 50%, 33,3% y 16,6% de los casos, respectivamente. El origen de la arteria renal derecha se observó craneal, a igual altura y caudal a la arteria renal izquierda en el 80%, 13,3% y 6,6% de los casos, respectivamente. En arterias renales dobles se observó un patrón única-única y única-ramificado en el 33,3%, 66,6% de los casos, respectivamente. La bifurcación de la arteria renal única se observó en el tercio proximal, medio y distal en 8,33%, 29,16% y 62,50% de los casos, respectivamente. El estudio demostró que en la arteria renal y sus ramas no existe un patrón anatómico común descrito en las referencias, al contrario, existe una alta variabilidad anatómica.

The anatomical literature describes, in general, that the canine kidney is supplied by a single renal artery. Different studies demonstrate the existence of anatomical variations in the prehiliar segment. The dog is used as a model for its easy urological collection, handling and size, there are numerous studies of intrarenal arterial pattern, however, there have been few studies on the provision prehiliar segment of the renal artery. The study aimed to describe and standardize the renal artery in dogs. Thirty pairs of canine kidneys were dissected and evaluated according to number of arteries, branches and site of renal artery bifurcation. The abdominal aorta was repleted with natural rubber latex and subsequently dissected. Renal artery was observed and only two in 90% and 10% of cases, respectively. The number of branches of the renal artery was only two, three and four at 50%, 33.3% and 16.6% of cases, respectively. The origin of the right renal artery was observed cranial to the same head and flow to the left renal artery in 80%, 13.3% and 6.6% of cases, respectively. In double renal arteries a unique only-pattern and single-branched was observed in 33.3%, 66.6% of cases, respectively. The bifurcation of the renal artery was observed only in the proximal, middle and distal 8.33%, 29.16% and 62.50% of cases, respectively. The study showed that in the renal artery and its branches there is no common anatomical pattern described in the literature, there is however, a high anatomical variability.

Developing a new endograft for the treatment of juxtarenal aortic aneurysms: definition and experimentation

OBJECTIVES: To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft. METHODS: A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50-60 kg to assess the new endograft model. RESULTS: The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility. CONCLUSIONS: The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms. .

Echobiometrics kidney and renal artery triplex doppler of canine fetuses / Ecobiometria renal e Doppler Triplex da artéria renal de fetos caninos

The aim of this study was to assess the sogographic parameters and biometry of canine fetal kidneys using the B mode, and to determinate the vascular index of the fetal renal arteries using the Doppler Triplex. Twenty four Shi-tzu and Pug, weighting between 4 and 10kg, aging between 4 and 6 years old were evaluated. The B mode, the fetal renal echobiometry and regularity of the renal surface, echotexture and cortex:medular ratio were evaluated during the 5th, 6th, 7th and 8th weeks of pregnancy. At the same time point of the B mode evaluation, the Doppler Triplex was carried out to assess the sistolic peak velocity (SPV), end diastolic velocity (EDV), vascular resistive (RI) and pulsatility index (PI). B mode revealed no fetal renal abnormalities and echobiometry showed important measurements during fetal development (P<0.0001). The values of the fetal renal arteries index (PSV and EDV) increased during the course of the pregancy (P<0.05) and remained constant for PI and RI (P>0.05). B mode and Doppler Triplex were important tools for the assessment of fetal renal development, using echobiometry and renal arterial index in canie fetuses...

O objetivo deste estudo foi avaliar, por meio da ultrassonografia convencional modo B, as características sonográficas e a biometria dos rins de fetos caninos, bem como determinar os índices vasculares da artéria renal dos conceptos ao Doppler Triplex. Foram utilizadas 24 fêmeas Shi-tzu e Pugs pesando de quatro a 10 kg e com idade entre quatro e seis anos. Ao modo B, a ecobiometria renal fetal, a regularidade da superfície renal, a ecotextura e a relação córtico-medular foram avaliadas durante a quinta, sexta, sétima e oitava semanas gestacionais. Ao Doppler Triplex, durante o mesmo período em que se realizou o exame convencional, foram determinados o pico de velocidade sistólica (PVS), a velocidade diastólica final (EDV) e o índice de resistência vascular (RI) e de pulsatividade (PI). Ao modo B, não foram detectadas alterações em rins fetais, e à ecobiometria renal dos fetos, foi possível determinar medidas renais importantes, verificando-se aumento das biometrias no decorrer do desenvolvimento fetal (P<0,0001). Ao Doppler Triplex, determinaram-se os índices vasculares da artéria renal fetal, sendo que os valores para PSV e EDV aumentaram no decorrer das semanas gestacionais (P<0,05) e permaneceram constantes para PI e RI (P>0,05). Concluiu-se que o modo B e o Doppler Triplex são ferramentas importantes para a avaliação do desenvolvimento renal fetal, com a utilização da ecobiometria renal e avaliação dos indices vasculares da artéria renal de fetos caninos...

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.

Study and clinical application of the anatomy of renal pedicles in retroperitoneoscopic nephrectomy / Estudio y aplicación clínica de la anatomía de los pedículos renales en la nefrectomía retroperitoneoscópica

This work aims to investigate the anatomical basis and clinical application value of renal pedicle locating in retroperitoneoscopic nephrectomy. To summarize the anatomical basis of renal pedicle locating through retrospective analysis of 278 cases of retroperitoneoscopic nephrectomy from July 2007 to September 2009, during which renal pedicle was located at about 2-4 cm below the medial arcuate ligament of the diaphragm in the space between the psoas major muscle and inferior vena cava (abdominal aorta) in the anatomical level of space before psoas. The operation of 278 patients was all successfully completed, where renal pedicle was quickly found. It took 3.5+/-1.3 min to locate the renal pedicle, and 95.6+/-23.8 min to operate. In retroperitoneoscopic nephrectomy, it is most preferable to locate renal pedicle in the space before psoas. The renal pedicle is located exactly at about 2-4 cm below the medial arcuate ligament of the diaphragm in the space between the psoas major muscle and inferior vena cava (abdominal aorta). The time for locating the renal pedicle can be shortened if the surgeon is familiar with the anatomic features of renal pedicle in retroperitoneoscopy, thereby saving the operation time.

El objetivo del estudio fue investigar las bases anatómicas y el valor de la aplicación clínica de la localización del pedículo renal en la nefrectomía retroperitoneoscópica. Para resumir las bases anatómicas de la localizacion del pedículo renal se realizó el análisis retrospectivo de 278 casos de nefrectomía retroperitoneoscópica desde Julio del 2007 a Septiembre del 2009. El pedículo renal se encontró a unos 2-4 cm por debajo del ligamento arqueado medial del diafragma en el espacio entre el músculo psoas mayor y vena cava inferior (o parte abdominal de la aorta) en el nivel anatómico del espacio anterior al músculo psoas mayor. La cirugía de los 278 pacientes fue completada exitosamente, encontrándose rápidamente el pedículo renal. El procedimiento para localizar el pedículo renal tomó 3,5+/-1,3 minutos y la cirugía completa 95.6+/-23.8 minutos. En la nefrectomía retroperitoneoscópica, es preferible localizar el pedículo renal en el espacio anterior al músculo psoas mayor. El pedículo renal se encuentra alrededor de 2-4 cm por debajo del ligamento arqueado medial de la membrana en el espacio entre el músculo psoas mayor y vena cava inferior (parte abdominal de la aorta). El tiempo para localizar el pedículo renal se puede disminuir si el cirujano está familiarizado con las características anatómicas del pedículo renal en la retroperitoneoscopía, ahorrando así el tiempo total de la cirugía.

Morphometric and quantitative analysis of theafferent renal artery variation

The kidney is a retroperitoneal organ that weight from 125 to 170 g in the adult men and 115to 155 g in adult women. Irrigation kidney is characterized by the presence of large anatomical variability thatmay be influenced by ethnic and to a lesser extent by gender. Among the variations, there may be the presenceof an accessory renal artery that is projected into the upper or lower end of the kidney. This research aimsto observe the incidence of anatomical variations of the afferent renal artery and quantify both right and leftkidney weight.Materials and Methods:We analyzed kidney weights and accessory renal artery variations in48 adult kidneys of both genders obtained from Institute of Anatomy of the University of Severino Sombra.Subsequently, we compared the mean weights of kidneys in order to ascertain whether there was significantdiscrepancy between the left and the right kidney. For this, we performed the Student t test considering aP < 0.05.Results:The mean weight of the right kidney was 140.4 ± 22.6 g and the left was 148.8 ± 20.5 g.In 40% of right kidneys was observed anatomic variation with the presence of accessory renal artery. To the leftkidney was observed a variation of 35%.Conclusion:We found that the accessory renal artery, when present,was more closely related to the end of the kidney especially in the right kidney.

Bilateral Origin of the Testicular Arteries from the Lower Polar Accessory Renal Arteries / Origen Bilateral de las Arterias Testiculares desde las Arterias Renales Polares Inferiores Accesorias

The gonadal arteries (testicular or ovarian arteries) emerge normally from the lateral aspect of the abdominal aorta, a little inferior to the renal arteries. Several other sites of origin of these arteries have been recorded with the renal and accessory renal arteries being the most common. In the present case report, the testicular arteries originated from the lower polar accessory renal arteries in both sides. The testicular veins followed had the usual origin and course, while an accessory renal vein was observed only in the right side. These anomalies were combined with an abnormal left ureter exiting from the lower pole of the kidney. Only one male cadaver among 77 adult human cadavers of Caucasian origin presented this set of variations (frequency: 1.3%). Variations of renal and gonadal vessels are important, as their presence could result in vascular injury of any accessory or aberrant vessel if the surgeon does not identify them.

Las arterias gonadales (testiculares o ováricas) se originan normalmente de la parte lateral de la parte abdominal de la aorta, distal a las arterias renales. Se han registrado otros lugares de origen de estas arterias, entre ellos, los más comunes en las arterias renales y renales accesorias. En el presente caso, las arterias testiculares se originaron bilateralmente desde las arterias renales polares inferiores accesorias. Las venas testiculares siguieron el origen y curso habitual, mientras que una vena renal accesoria sólo se observó en el lado derecho. Estas anomalías se combinaron con un uréter izquierdo anormal que salía desde el polo inferior del riñón. Sólo un cadáver de sexo masculino, de origen caucásico, entre los 77 cadáveres humanos adultos, presentaba este conjunto de variaciones (frecuencia: 1,3%). Las variaciones de los vasos renales y gonadales son importantes. Su presencia, si el cirujano no los identifica, puede resultar en lesiones vasculares de algún vaso accesorio o aberrante.

Normal and variant anatomy of renal hilar structures and its clinical significance / Anatomía normal y variante de las estructuras hiliares renales y su significancia clínica

Advanced imaging techniques have resulted in increasing use of minimally invasive approaches for nephron sparing surgeries of kidney. Need for precise knowledge of normal and variant anatomy of vascular pedicle of kidney is thus justified. Ample literature is available on the variations in the intrarenal vascular pattern of the kidney, which are seen frequently. But the variation in arrangement of structures at the renal hilum has not gained much interest up till now. One hundred (51 right and 49 left) embalmed kidneys were utilized for the present study. Careful dissection of renal hilar structures was carried out to observe antero-posterior relationship of structures at the hilum of the kidney. In majority (73 percent), the arrangement was not according to the normal textbook description i.e. renal vein, renal artery and pelvis arranged antero-posteriorly. In 31 percent anterior division of renal artery was seen in front of renal vein at the hilum, whereas, in 50 percent cases the pelvis was not the posterior most relation. The variable patterns observed were classified into five types. In cases of renal hilar tumors laparoscopic partial nephrectomy is being done with a limited field of vision. Knowledge of these variations is useful for operating surgeons to identify and individually clamp the hilar structures, which is advantageous over en-bloc clamping.

Las técnicas avanzadas de imagen han permitido aumentar el uso de abordajes mínimamente invasivos para la cirugía conservadora del nefrón. Por esto, se justifica la necesidad de un conocimiento preciso de la anatomía normal y las variaciones anatómicas del pedículo vascular del riñón. Es amplia la literatura disponible sobre variaciones en el patrón vascular intrarrenal, lo que se observa con frecuencia. Sin embargo, hasta ahora, la variación en la disposición de las estructuras en el hilio renal no ha generado mucho interés. Se utilizaron 100 riñones fijados (51 derechos y 49 izquierdos) para el estudio. Una cuidadosa disección de las estructuras hiliares renales se llevó a cabo para observar la relación antero-posterior de las estructuras en el hilio del riñón. En la mayoría de los casos (73 por ciento), las características no estaba de acuerdo con la descripción normal de la vena renal, es decir, con la arteria renal y la pelvis renal dispuestos en sentido anteroposterior. Los patrones de las variables observadas fueron clasificadas en cinco tipos. En el 31 por ciento de los casos la división anterior de la arteria renal estaba anterior a la vena renal en el hilio, mientras que, en el 50 por ciento de los casos, la pelvis no estaba posterior. En los casos de tumores renales hiliares la nefrectomía parcial laparoscópica se realiza con un limitado campo de visión. El conocimiento de estas variaciones es útil para un adecuado desempeño de los cirujanos al identificar y separar individualmente las estructuras hiliares, que es una ventaja sobre la separación en bloque.

Doppler de arterias renales: parte 3 / Renal artery doppler: part 3

En esta última parte del artículo se describe el uso de doppler en patología venosa renal y trombosis venosa renal.

Doppler de arterias renales: parte 2 / Renal artery doppler

En esta parte del artículo se describen la fisiopatología y etiología de la estenosis renal, así como metodología y técnicas para su idenficación por ultrasonido...

Variation in the Origin of the Testicular Arteries and Drainage of the Right Testicular Vein / Variación en el Origen de las Arterias Testiculares y el Drenaje de la Vena Testicular Derecha

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.

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias / Study of arterial pattern of 200 renal pedicle through angiotomography

OBJETIVO: Verificar a prevalência e a distribuição das artérias renais e de seus ramos in vivo, relacionando as particularidades encontradas nas artérias renais com o sexo e sua lateralidade. MÉTODO: Duzentos pedículos renais foram estudados por meio de angiotomografias e suas artérias analisadas de acordo com número, posição de origem, calibre, comprimento e trajeto em relação aos segmentos renais. Sua frequência e lateralidade foram pesquisadas quanto ao sexo e idade. RESULTADOS: Foram observadas múltiplas artérias em 61,5 por cento dos pedículos (56 por cento à direita e 67 por cento à esquerda), ocorrendo em 65 por cento dos homens e 58 por cento das mulheres. A origem aórtica para as múltiplas artérias foi mais frequente à direita e, com maior frequência, as artérias renais se originaram entre as vértebras L1 e L2 como divisões pré-hilares da artéria principal. O comprimento médio da artéria principal foi maior em rins direitos com artéria única. Não houve diferença entre o diâmetro da artéria renal principal. CONCLUSÃO: Existe maior prevalência das múltiplas artérias renais do que aquela descrita na literatura, sem diferença entre os sexos ou lateralidade. As artérias renais originaram-se com maior frequência entre as vértebras L1 e L2, como divisões pré-hilares da artéria principal e com trajeto ao hilo do rim. O comprimento médio da artéria principal é maior à direita e nos rins com artéria única. Não houve diferença no diâmetro da artéria renal principal entre rins com artérias únicas e múltiplas.

OBJECTIVE: To investigate the prevalence and distribution of renal arteries and their branches in vivo, correlating the particularities found in them with sex and laterality. METHODS: Two hundred renal pedicles were studied by CT angiography and its arteries analyzed according to number, position of origin, size, length and trajectory in relation to renal segments. Its frequency and laterality were surveyed regarding gender and age. RESULTS: There were multiple arteries in 61.5 percent of the pedicles (56 percent in the right and 67 percent in the left), occurring in 65 percent of men and 58 percent of women. The aortic origin to the multiple arteries was more frequent on the right and, more often, the renal arteries originated between vertebrae L1 and L2 as pre-hilar division of the main artery. The average length of the main artery was higher in right kidneys with a single artery. There was no difference between the diameters of the main renal arteries. CONCLUSION: There is a higher prevalence of multiple renal arteries than the one described in the literature, with no difference for gender or laterality. The renal arteries originated more frequently between vertebrae L1 and L2, with divisions of the pre-hilar route and main artery to the hilum of the kidney. The average length of the main artery is greater on the right and in kidneys with single artery. There was no difference in diameter between the main renal artery between kidneys with single and multiple arteries.