Anatomical variations of the renal arterial vasculature: An Australian perspective

The prevalence of accessory renal arteries in sudanese population in Khartoum State: a cross-sectional CT study from 2017 to 2020

BACKGROUND

Renal artery variations are clinically significant due to their implications for surgical procedures and renal function. However, data on these variations in Sudanese populations are limited. This study aimed to determine the prevalence and characteristics of renal artery variations in a Sudanese population.

METHODS

A cross-sectional retrospective study was conducted in Khartoum state from October 2017 to October 2020. A total of 400 Sudanese participants who underwent abdominal CT scans were included. Data on demographic characteristics, kidney measurements, and renal vasculature were collected and analyzed using descriptive statistics and inferential tests.

RESULTS

The mean age of participants was 46.7 ± 18 years, with a nearly equal gender distribution. Overall, renal artery variations were present in 11% of participants, with accessory renal arteries observed in 6% of the study population. Among those with accessory vessels, 50% were on the right side, 29.2% on the left, and 20.8% bilateral, distributed across hilar 29.2%, lower polar 29.2%, and upper polar 41.7% regions. No significant associations were found between accessory renal arteries and age or gender (p-value > 0.05). However, participants with accessory renal arteries exhibited significantly narrower width 5.0 ± 1.4 than those with no with accessory renal arteries 5.8 ± 1.1 (p-value 0.002) Early dividing renal arteries were found in 5% of participants, with nearly half being bilateral. No significant associations were found between the presence of early dividing renal arteries and demographic or renal measurements (p-value > 0.05).

CONCLUSION

This study provides valuable insights into the prevalence and characteristics of renal artery variations in a Sudanese population. The findings contribute to our understanding of renal anatomy in this demographic and can inform clinical practice and surgical planning, particularly in renal transplantation and other renal procedures.

A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects

Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.

Multidetector computed tomography angiography study of the renal arterial vasculature anatomy and its variations in a Bulgarian adult population

PURPOSE

Renal arterial anatomy has a great clinical importance during surgical and endovascular procedures. However, comprehensive data on renal arterial variations in the Bulgarian population has not yet been provided. The aim of this study was to conduct a detailed research about the normal anatomy and variations of the renal arteries in the Bulgarian population.

METHODS

Five hundred sixty-one patients underwent contrast-enhanced multidetector computed tomography scans for the period 2016-2021. The images were retrospectively reviewed. Number, branching pattern, origin level and course of the renal arteries were noted. Data were categorized on the basis of laterality, gender and symmetry.

RESULTS

Only 46.3% of the patients exhibited normal renal arterial anatomy. Variations were observed in 301 patients (53.7%). The most common variant was the presence of accessory renal arteries (ARA), discovered in 41.2% of the subjects. There was no significant difference based on gender and laterality (p > 0.05). Hilar ARA (72.6%) were significantly more common than polar ARA (p < 0.001). The most common origin location of the main renal arteries and ARA was the aorta, followed by the common iliac arteries. Early division was observed in 21.7% of the patients, significantly more common on the right. Precaval course was found in 0.5% of the right main renal arteries and in 30% of ARA and the difference was significant (p < 0.001).

CONCLUSION

These results show novel insight into the prevalence of renal arterial variations in the Bulgarian population. Anatomic renal vasculature variants are common therefore awareness is crucial for the success of surgical and interventional procedures.

Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations

Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.

Long-term outcomes of left versus right laparoscopic living donor nephrectomy with multiple renal arteries

OBJECTIVES

The objective of this study is to compare the long-term graft outcomes of left versus right donor nephrectomy with multiple renal arteries, and therefore creating a reference for the expansion of the potential living kidney donor pool.

METHODS

Laparoscopic live donor nephrectomy cases between May 2010 and October 2020 were included in this retrospective cross-sectional study. The data relating to donor and recipient demographics, surgical and anatomical characteristics, recipient and graft status were retrieved and compared using nonparametric statistical methods and multivariate regression. Analyses were fit for survival factors.

RESULTS

A total of 1009 recipients were included in this retrospective cross-sectional study with their donors. 16.7% of the donors had been discovered to have more than one renal artery supplying the donated kidney. The acute rejection rate was 12.8%. Death-censored graft survival at post-operative year 5 for single renal artery transplants was 89.6%, 89.5% for left-sided multiple renal arteries, and 88.2% for right-sided ones.

CONCLUSIONS

Both right donor nephrectomy and left donor nephrectomy are safe procedures with no significant negatively impacted rates for neither survival nor complications of the recipients in the long-term, compared to single renal artery ones.

Angioplasty and angiorrhaphy efficiency in renal transplantation scenarios with multiple arteries and veins

OBJECTIVE

To evaluate post-transplant renal perfusion and vascular complications of renal transplantation in patients with the end-stage renal disease (ESRD) operated in the presence of multiple blood vessels at Viet Duc University Hospital.

METHODS

A non-controlled interventional study was performed prospectively and retrospectively between January 2012 and June 2018. The study sample includes 84 patients who underwent live donor renal transplantation in the presence of multiple arteries (RAs) and veins (RVs) at Viet Duc Hospital. The surgical procedure comprised of end-to-side anastomosis to the recipient's external iliac artery/vein, gun barrel anastomosis of two RAs/RVs, anastomosis of the small RA/RV to the main RA/RV, anastomosis of the polar artery to the inferior epigastric artery, small artery constriction, and their combinations.

RESULTS

On clamp removal, 94% of the transplanted kidneys were solid and evenly pink, 3.6% had bruises due to small artery constriction, 1.2% were poorly perfused due to vasoconstriction, and 1.2% had renal artery branches occluded by blood clots and required anastomosis re-opening. All kidneys began to produce urine on the operating table.

CONCLUSION

A high success rate of renal transplantation in the presence of multiple blood vessels requires that surgeons have sufficient experience and use a combination of angioplasty and angiorrhaphy techniques.

The Anatomy of Renal Arteries in Adults

Detailed extraparenhymal renal hilar dissection was performed on 110 fixed cadaveric kidneys (60 from male cadavers and 50 from female cadavers). We analyzed the number of renal arteries, angles between renal arteries and abdominal aorta, length and diameter of the renal arteries. Multiple renal arteries were present in 20.9% of cases, with a slightly higher incidence on the right side (21.8%: 20.0%). The angle between the aorta and the RRA varied from 30° to 100° with a mean of 64.1°, while the angle between the abdominal aorta and the LRA was 40° to 115°, with a mean of 67.3°. The external caliber of the RRA at the point of origin from the abdominal aorta was 5 mm to 9.1 mm, with a mean of 6.8 mm. The same caliber of the LRA was 3.7 to 9.6 mm with a mean of 7.0 mm. The average length of the renal artery from the point of origin from the abdominal aorta to the branching point was 36.2 mm for the right renal artery and 30.7 mm for the left renal artery. The average length of the renal artery from the point of origin from the abdominal aorta to the renal hilum was 65.1 mm for the right one and 54.7 mm for the left one. Knowledge of the number of renal arteries, their mode of entry into the kidney, the angles they build with the abdominal aorta, their diameter and length has practical applications in interventional radiology and surgery of the kidney and its environment.

A Case Study of Malrotated Kidneys with Asymmetric Multiple Renal Arteries, Variant Venous Drainage, and Unilateral Ureteral Duplication

Variations in the arterial, venous, and ureteral patterning of the right (r) and left (l) kidneys are common; however, concomitant involvement with all three systems is rare. Specimens that demonstrate anatomic variation across multiple systems provide an opportunity to illustrate links between anatomic concepts, embryologic development, clinical practice, and education. During anatomic study of the abdominal cavity, a total of five major arteries (3l and 2r) emerged from the aortic and common iliac axes in a cadaveric donor. Through continued study, multiple contributing veins, of different caliber, coalesced into four major renal veins (2l and 2r) that returned blood from the kidneys to the inferior vena cava (IVC) at different locations. In addition, unilateral duplication of the kidney with concomitant ureters was evident on the right side. Both ureters continued inferiorly and independently entered the bladder, each with an observable orifice adjacent to the bladder trigone. Most evident in the specimen was the anteriorly directed hilum for both kidneys. Reported measures for each of the observed anatomic variations suggest that the current specimen has an estimated incidence of less than 0.3%. This comparatively rare specimen provides an example of important anatomic concepts that are relevant to educational and clinical practices.

The size of the renal artery orifice contributes to laterality of acute renal infarction

BACKGROUND

Acute renal infarction (ARI) is a rare disease with atrial fibrillation being its main cause. The possible laterality of ARI is controversial. This study aimed to evaluate the association between anatomical features of the renal arteries and ARI.

METHODS

This was a single-center cross-sectional study that evaluated the anatomical and clinical features of renal arteries. The anatomical features of the renal arteries were assessed using computed tomography.

RESULTS

A total of 46 patients (mean age 71.3 ± 14.0 years; men, 59%) were enrolled. ARI involved the left kidney in 63%, right kidney in 28%, and both kidneys in 9% of patients. The right renal artery orifice was often higher than that of the left renal artery (71%). The angle of divergence from the abdominal aorta was similar on both sides. The left renal artery orifice was larger than that of the right (83 ± 24, 72 ± 24 mm²; p = 0.03, respectively). A larger left orifice was present in 72% of all cases. ARI involved the side with the larger orifice in 64% of patients.

CONCLUSION

The size of the renal artery orifice may be a factor that contributes to the laterality of ARI. Assessment of anatomical features is important when considering the laterality of the disease.