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Ogoyama Y, Kario K. Aspects of renal function and renal artery anatomy as indications for renal denervation. Hypertens Res 2024:10.1038/s41440-024-01860-y. [PMID: 39210084 DOI: 10.1038/s41440-024-01860-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
Renal denervation (RDN) is a minimally invasive, endovascular catheter-based procedure using radiofrequency, ultrasound, or alcohol-mediated ablation to treat resistant hypertension. As more attention is focused on the renal sympathetic nerve as a cause and treatment target of hypertension, understanding the anatomy of the renal artery may have important implications for determining endovascular treatment strategies as well as for future selection of devices and appropriate candidates for RDN treatment. However, the anatomical structure of the renal artery (RA) is complex, and standardized morphological evaluations of the RA structure are lacking. Computed tomography angiography or magnetic resonance angiography imaging is useful for assessing RA anatomy before conducting RDN. RA echocardiography is an established noninvasive screening method for significant stenosis. Major randomized controlled trials have limited enrollment to patients with preserved renal function, usually defined as an estimated glomerular filtration rate (eGFR) ≥ 45 mL/min/1.73 m2. Therefore, the level of renal function at which RDN is indicated has not yet been determined. This mini-review summarizes the characteristics of renal artery anatomy and renal function that constitute indications for renal denervation. (Role of Clinical Trials: K. Kario is an Executive Committee Principal Investigator for the Spyral OFF MED, the Spyral ON MED, the DUO and the REQUIRE; a Coordinating investigator for the TCD-16164 study; a Site Principal Investigator for the HTN-J, the Spyral OFF MED, the Spyral ON MED, the DUO, the REQUIRE and the TCD-16164 study). Evaluation of renal arteries for radiofrequency renal denervation. A Simultaneous quadrantal ablations at four sites in the main renal artery or the equivalent renal artery to the main renal artery. B If there is a renal artery branch with a diameter >3 mm in the middle of the main renal artery, this branch is the distal end of the main renal artery. In this case, four simultaneous and quadrantal ablations can be performed on the equivalent renal arteries. C Four simultaneous and quadrantal ablations can be performed in the branch renal artery. D Sonication should be spaced at least 5 mm (one transducer*) apart. Perform 2 to 3 mm proximal to the arterial bifurcation. Perform 2 to 3 mm distal to the abdominal aortic inlet.
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Affiliation(s)
- Yukako Ogoyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Kumar N, Padur AA, Gadahad MRK, Shanthakumar SR. Clinically important left superior polar artery giving rise to a left inferior suprarenal artery and an aberrant left inferior polar artery: a case report. J Vasc Bras 2023; 22:e20230012. [PMID: 37576723 PMCID: PMC10421583 DOI: 10.1590/1677-5449.202300122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/06/2023] [Indexed: 08/15/2023] Open
Abstract
The renal arteries arise from the lateral side of the abdominal aorta at the L2 vertebral level, just below the origin of the superior mesenteric artery. Multiple aberrant renal arteries can pose difficulties in renal transplantation, interventional radiological and urological procedures, renal artery embolization, angioplasty, or vascular reconstruction for congenital and acquired lesions. We present a case of a left kidney supplied by the left renal artery along with superior and inferior polar arteries, arising from the aorta and inferior mesenteric artery respectively. The inferior mesenteric artery was crossed by the left ureter and inferior mesenteric vein. The superior polar artery gave rise to an inferior suprarenal artery making the variation important for clinicians and surgeons.
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Affiliation(s)
- Naveen Kumar
- RAK Medical & Health Sciences University – RAKMHSU, RAK College of Medical Sciences, Ras-Al-Khaimah, United Arab Emirates.
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Mihaylova E, Groudeva V, Nedevska M. Multidetector computed tomography angiography study of the renal arterial vasculature anatomy and its variations in a Bulgarian adult population. Surg Radiol Anat 2023; 45:289-296. [PMID: 36729216 DOI: 10.1007/s00276-023-03092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Evgeniya Mihaylova
- Department of Radiology, Prof. Dr. Alexander Chirkov University Hospital, Pencho Slaveykov Blvd, 1431 52A, Sofia, Bulgaria.
- Department of Radiology, Medical University Sofia, Sofia, Bulgaria.
| | - Violeta Groudeva
- Department of Radiology, Prof. Dr. Alexander Chirkov University Hospital, Pencho Slaveykov Blvd, 1431 52A, Sofia, Bulgaria
- Department of Radiology, Medical University Sofia, Sofia, Bulgaria
| | - Maria Nedevska
- Department of Radiology, Prof. Dr. Alexander Chirkov University Hospital, Pencho Slaveykov Blvd, 1431 52A, Sofia, Bulgaria
- Department of Radiology, Medical University Sofia, Sofia, Bulgaria
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Karayagiz AH, Besli S, Yilmaz G, Ozdemir E, Cakir U, Berber I. Long-term outcomes of left versus right laparoscopic living donor nephrectomy with multiple renal arteries. Eur Surg Res 2022; 63:46-54. [PMID: 35100577 DOI: 10.1159/000522315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Abdulhak Hamit Karayagiz
- Department of General Surgery, Istanbul Esenyurt Necmi Kadioglu Public Hospital, Istanbul, Turkey
| | - Sevval Besli
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Gulay Yilmaz
- Department of Nephrology, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ebru Ozdemir
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ulkem Cakir
- Department of Nephrology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ibrahim Berber
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
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Correlation between Renal Artery Anatomy and Hypertension: A Retrospective Analysis of 3000 Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:9957361. [PMID: 35003315 PMCID: PMC8731270 DOI: 10.1155/2021/9957361] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
Objective To assess the correlation between renal artery anatomy and blood pressure in Undiagnosed Hypertension and Diagnosed Hypertension. Methods The renal artery CT scanning imaging data and laboratory data of 3000 inpatients and outpatients were collected retrospectively in 4 centers of China. Morphometric parameters were assessed using the quantitative vascular analysis (unit: mM). Results 687 cases (23.2%) had accessory renal arteries unilaterally, and 216 cases (7.3%) had bilateral accessory renal arteries, including left kidney 825 (27.9%) and right kidney 798 (27.0%). The presence of accessory renal arteries and renal artery branches was higher in the diagnosed hypertension group as compared with the undiagnosed hypertension group (MARB, pp < 0.001; ARA, p < 0.001; others, p < 0.001). Consequently, multivariate regression analysis showed that age (OR = 2.519 (95% CI: 0.990–6.411, p < 0.001)), dyslipidemia (OR = 1.187 (95% CI: 0.960–1.454, p = 0.007)), renal hilum Outside the main renal artery branch (MRAB) (OR = 2.069 (95% CI: 1.614–2.524, p = 0.002)), and accessory renal artery (ARA) (OR = 2.071 (95% CI: 1.614–2.634, p = 0.001)) were risk factors of hypertension. In addition, higher renin activity was associated with ARA patients (2.19 ± 2.91 vs. 1.75 ± 2.85, p < 0.001). Conclusions When comparing renal arteries side by side, the anatomical length of the renal arteries is significantly different. In addition, the prevalence of accessory renal arteries and renal artery branches is higher in the hypertension group. The auxiliary renal artery and the main renal artery branch outside the renal portal are independent factors of hypertension. Renal sympathetic nerve activity is affected by renin activity and is related to the accessory renal artery.
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Pradhay G, Gopidas GS, Karumathil Pullara S, Mathew G, Mathew AJ, Sukumaran TT, Pavikuttan N, Sudhakaran R. Prevalence and Relevance of Multiple Renal Arteries: A Radioanatomical Perspective. Cureus 2021; 13:e18957. [PMID: 34815903 PMCID: PMC8606020 DOI: 10.7759/cureus.18957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
Background: A single renal artery supplies the kidney in 70% of the population but variation exists in the remaining 30%. Multiple renal arteries (MRA) in different permutations and combinations are one of the many forms of variants. Lack of awareness of multiplicity could have detrimental effects on the outcome of renal surgery. The present study aims at identifying the variants of renal artery based on its origin, multiplicity, and portal of entry in a cohort of people belonging to Southern India and its clinical implications thereof. Methods: Multi-detector CT (MDCT) images of renal vasculature of 100 kidneys from 50 live kidney donors who attended the Department of Nephrology of our institution, from 2016 to 2018 were collected and studied for variations in renal arterial anatomy. Results: Out of the 18% of kidneys observed with multiple renal arteries, 88.8% had double renal arteries (DRA) and 11.1% had triple renal arteries (TRA). Common types of the double renal arteries were - two hilar arteries (31.3%) and one hilar with one inferior polar artery (IPA, 31.3%). Triple renal arteries types - 50% with one hilar, one superior polar, and one inferior polar; 50% with two hilar and one inferior polar artery. No statistically significant association was noted between the incidence of multiple renal arteries and its laterality (p-value=0.193). Conclusion: A thorough understanding of the renal artery variants is crucial for safe and efficacious uro-radiological interventional procedures.
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Affiliation(s)
- Girish Pradhay
- Anatomy, Malabar Medical College Hospital and Research Centre, Calicut, IND
| | - Geetha S Gopidas
- Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | | | - Georgie Mathew
- Urology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Asha J Mathew
- Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Tintu T Sukumaran
- Anatomy, Amrita School of Medicine , Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Nanditha Pavikuttan
- Anatomy, Amrita School of Medicine , Amrita Institute of Medical sciences, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Rathi Sudhakaran
- Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, IND
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Gebremickael A, Afework M, Wondmagegn H, Bekele M. Renal vascular variations among kidney donors presented at the national kidney transplantation center, Addis Ababa, Ethiopia. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sanghvi K, Wang Y, Daemen J, Mathur A, Jain A, Dohad S, Sapoval M, Azizi M, Mahfoud F, Lurz P, Sayer J, Levy T, Zagoria R, Loening AM, Coleman L, Craig D, Horesh-Bar M, Kirtane AJ. Renal artery variations in patients with mild-to-moderate hypertension from the RADIANCE-HTN SOLO trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:58-65. [PMID: 34620570 DOI: 10.1016/j.carrev.2021.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the variability of renal artery (RA) anatomy and presence of RA-pathology in patients with mild-to-moderate hypertension enrolled in the RADIANCE-HTN SOLO trial. BACKGROUND RADIANCE-HTN SOLO was a multicenter, international, blinded, randomized, sham-controlled trial evaluating ultrasound-based endovascular renal denervation (RDN) in patients with mild-to-moderate hypertension while off antihypertensive medications. METHODS Eligible subjects had pre-randomization renal CT- or MR- angiography (CTA, MRA) to confirm anatomic suitability and to define RA ablation sites. All images were sent for independent review for evaluation of RA anatomy and other vascular pathology. RESULTS A total of 324 patients underwent RA imaging (282 CTA and 42 MRA). Of those, 178 had simple anatomy with a single left and single right RA with mean diameters of 5.4 ± 0.9 and 5.1 ± 0.8 mm and mean lengths of 40.0 ± 12.9 and 52.0 ± 13.1 mm, respectively. Twenty-seven patients (8.3%) had unilateral or bilateral dual RAs with mean diameters of 4.0 ± 0.9 mm on the left and 3.9 ± 0.9 mm on the right. Forty percent (129/324) of patients had at least 1 accessory RA, with mean accessory diameters of 2.4 ± 0.8 mm on the left and 2.3 ± 0.8 mm on the right. Twenty-eight patients (8.6%) had at least 1 short (<25 mm) main RA. Incidental findings included: 9 patients (2.8%) with atherosclerotic RA stenosis ≥30%, 9 patients (2.8%) with fibromuscular dysplasia of RA and 2 patients (0.6%) with kidney and adrenal gland tumors. CONCLUSIONS Pre-procedure CTA or MRA imaging is a valuable aid in assessing RA anatomy prior to RDN because of variable RA anatomy. CTA or MRA may detect RA lesions, and renal or adrenal tumors which may need additional workup prior to consideration of RDN. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02649426.
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Affiliation(s)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, NL, the Netherlands
| | - Anthony Mathur
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ajay Jain
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Suhail Dohad
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Michel Azizi
- Université de Paris, F-75006 Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France; INSERM, CIC1418, F-75015 Paris, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg, Saar, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Ronald Zagoria
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | | | | | | | | | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
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Cadaveric study of arterial renal anatomy and its surgical implications in partial nephrectomy. Surg Radiol Anat 2021; 43:1449-1459. [PMID: 34021803 DOI: 10.1007/s00276-021-02769-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/13/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Partial nephrectomy is gaining, nowadays, more interest in oncologic kidney surgery. This type of surgery requires the good knowledge of vascular renal anatomy to make it safe and to guarantee good functional and oncological outcomes. This paper exposes the clinical implication of the arterial renal anatomy in nephron-sparing surgery. METHODS This is a cadaveric study of 71 human kidneys performed at Charles Nicolle mortuary. The right and left kidneys with surrounding tissues were removed en bloc with the adjacent part of the aorta and inferior vena cava, cleared and studied. Colored resin was injected in each artery, vein, and urinary ducts, with a specific color code for each structure. Corrosion technique was used to eliminate the surrounding tissue, leaving only the colored resin matrix. The Ternon anatomic classification of the inferior polar artery, based on its emergence point was used. RESULTS Multiple renal arteries were noted in 9.85% of casts. Anterior and posterior division of main renal artery was found in 95.7% of cases. Posterior segmental artery crossed posteriorly the upper caliceal infundibulum and the renal pelvis in 93% of cases. The upper renal pole was vascularized by an apical segmental artery in 16.9% of cases and a superior polar artery in one case (1.4%). The mid pole of the kidney was supplied by a unique anterior branch and a single posterior branch in 40% of cases. Inferior polar artery was found in 52 casts (73.23%). Type I of Ternon was found in 6 casts (11.53%), Type II in 25 cases (48.07%), Type III in 19 cases (36.53%), Type IV in 2 cases (3.84%), and type V in 13 casts (25%). CONCLUSION Renal vascular anatomy presents large variations. Good knowledge of the segmental arterial anatomy of the kidney is a primordial to a safe partial nephrectomy. Good preoperative vascular mapping can be of great help for the surgeon.
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Chowki P, Patil R. Comparison of human renal arteries in cadavers and in computed tomography scans – A morphometric study. J ANAT SOC INDIA 2021. [DOI: 10.4103/jasi.jasi_193_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahajan AD, Patel ND, Singh Pal L, Bathe S, Darakh PP, Patil M. Retrospective Analysis of the Comparison Between Single Renal Artery Versus Multiple Renal Arteries in Living Donor Kidney Transplant: Does It Affect the Outcome? EXP CLIN TRANSPLANT 2020; 19:38-43. [PMID: 33272157 DOI: 10.6002/ect.2020.0244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There is an increased risk of vascular complications in kidney transplant for allografts with multiple renal arteries versus a single renal artery. We compared the clinical outcomes of living donor kidney transplant recipients who received allografts with a single renal artery versus multiple renal arteries. MATERIALS AND METHODS This retrospective analysis included all living-related donor kidney transplants that were performed by a single skilled urologist. All donor nephrectomies were performed by open method. The left kidney was preferred over the right for donor nephrectomy, except in cases of vascular problems or other contraindications, for which the right kidney was preferred. In most of the cases, kidneys were placed in the right iliac fossa for transplant by an extraperitoneal approach. RESULTS Of 97 living donor kidney transplants, 82 had a single renal artery (group 1) and 15 had multiple renal arteries (group 2). Patients ranged in age from 18 to 76 years old. Recipient ages (33.00 vs 29.46 years) and baseline serum creatinine values (8.61 vs 8.82 mg/dL) were comparable in groups 1 and 2 (P > .05). However, mean operative time and total ischemia time were significantly higher in the multiple renal artery group (221 and 53.45 minutes, respectively) compared with the single renal artery group (202 and 77.6 minutes, respectively). Graft survival at 1 year was 95.12% in the single renal artery group and 93.33% in the multiple renal artery group. Patient survival at 1 year was 96.34% in the single renal artery group and 93.33% in the multiple renal artery group. CONCLUSIONS The safety of kidney transplants of allografts with multiple renal arteries is equal to the safety of transplants of allografts with a single renal artery in terms of vascular complications and acute tubular necrosis, as well as patient and graft survival.
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Affiliation(s)
- Abhay Dinkar Mahajan
- From the Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
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Dgebuadze M, Svanidze G, Gachechiladze D. QUANTITATIVE MORPHO-FUNCTIONAL ANALYSIS OF SIMMETRY-ASIMMETRY CONDITION OF HUMAN NORMAL KIDNEY. BULGARIAN JOURNAL OF VETERINARY MEDICINE 2020. [DOI: 10.15547/tjs.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the present research was to perform quantitative morpho-functional analysis of the symmetry-asymmetry condition of human normal autopsy and “live” kidneys using the complex of morphological and ultra-sonographic methods. METHODS: Morphometric study of 10 autopsy kidneys of healthy men 36 - 60 years of age was conducted; retrospective analysis of data obtained by vital ultra-sonographic study of 65 kidneys of men without renal diseases at the same age period was performed as well. All kidneys were with a single renal artery. RESULTS: The kidney length and width are statistically significantly greater on right, than on left, but there were no statistically significant differences between right and left kidneys in thickness of the kidney and size of its parenchyma. Results of morphometric study of autopsy renal glomeruli, as well as multislice computed tomographic angiography and doppler investigation of renal artery in color duplex scan mode did not show any statistically significant differences on right and on left. CONCLUSIONS: For determining of the standard quantitative indicators of kidney it is necessary to take into account the age and gender of the studied people, as well as the effect of side.
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Abd Elrahim E. Computed tomography evaluation of renal artery morphometry in adults. The impact of age and gender. Saudi Med J 2020; 41:34-37. [PMID: 31915792 PMCID: PMC7001056 DOI: 10.15537/smj.2020.1.24795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the effect of age and gender on diameters and lengths of the renal arteries. Methods: This is a retrospective study. A total of 50 asymptomatic volunteers were selected randomly and scanned by multi-detector CT to assess the diameters and lengths of the renal arteries. The study conducted at King Abdulaziz Specialized Hospital (KAASH) and King Faisal Hospitals, Taif, Saudi Arabia between October 2017 and March 2018. The lengths and diameters of the main arteries were measured and compared to age and gender of the participants. Results: The mean length of right renal artery was significantly longer than the left one (4.47±.70 versus 3.714±.68 cm, p less than 0.001). Length of right and left renal arteries were significantly higher in males than females (p=0.02 and p=0.03). Diameters of both left and right renal arteries were higher in males than females (5.482±1.37 versus 5.288±1.09 cm, and 5.544±1.14 versus 5.188±1.05 cm). The diameters of renal arteries varied significantly with age, specifically in elders (p=0.001). CONCLUSION The mean length and mean diameter were significantly different between females and males, and between left and right main renal arteries. Age and gender have a significant impact on the length and diameters of main renal arteries.
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Affiliation(s)
- Elrashed Abd Elrahim
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, Kingdom of Saudi Arabia. E-mail.
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The Anatomy of Renal Arteries in Adults. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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.
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Majos M, Polguj M, Stefańczyk L, Derlatka-Kochel M, Wachowski M, Majos A. Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study. BMC Cardiovasc Disord 2019; 19:181. [PMID: 31362712 PMCID: PMC6668124 DOI: 10.1186/s12872-019-1163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter. Method The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter. Results R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150–0.5083 and 0.0863–0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants (p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men (p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys (p = 0.3123). Spearman’s coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled − 0.36. Conclusion The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.
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Affiliation(s)
- Marcin Majos
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland, Żeligowskiego 7/9, 90-752, Łódź, Poland.
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Magdalena Derlatka-Kochel
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Mariusz Wachowski
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland
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Lauder L, Ewen S, Tzafriri AR, Edelman ER, Lüscher TF, Blankenstijn PJ, Dörr O, Schlaich M, Sharif F, Voskuil M, Zeller T, Ukena C, Scheller B, Böhm M, Mahfoud F. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension. EUROINTERVENTION 2019; 14:121-128. [PMID: 29633939 DOI: 10.4244/eij-d-18-00112] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS With increasing attention to renovascular causes and targets for hypertension there arises a critical need for more detailed knowledge of renal arterial anatomy. However, a standardised nomenclature is lacking. The present study sought to develop a standardised nomenclature for renal anatomy considering the complexity and variation of the renal arterial tree and to assess the applicability of the nomenclature. METHODS AND RESULTS One thousand hypertensive patients underwent invasive selective renal artery angiography in nine centres. Further, renovasography was performed in 249 healthy swine as a surrogate for normotensive anatomy. Anatomical parameters were assessed by quantitative vascular analysis. Patients' mean blood pressure was 168/90±26/17 mmHg. The right main renal artery was longer than the left (41±15 mm vs. 35±13 mm, p<0.001), but the left had a greater diameter (5.4±1.2 vs. 5.2±1.2 mm, p<0.001). Accessory renal arteries and renal artery disease were documented in 22% and 9% of the patients, respectively. Other than exhibiting a longer left main renal artery in uncontrolled hypertensives (+2.7 mm, p=0.034) there was no anatomical difference between patients with controlled and uncontrolled hypertension. Main renal artery mean diameter was smaller in patients with impaired kidney function (GFR <90 ml/min, left -0.5 mm, right -0.4 mm, both p<0.001). CONCLUSIONS Renal arterial anatomy differs between sides but shows no difference between patients with and without blood pressure control. Impaired GFR was associated with small main renal artery diameter.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg/Saar, Germany
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17
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Cenal U, Erturk T, Karayagiz AH, Ozdemir E, Polatkan SV, Cakir U, Berber I. Geographic Distribution of Multiple Arteries and Veins of 878 Kidney Donors From a Transplant Center in Turkey. Transplant Proc 2019; 51:1086-1088. [PMID: 31101176 DOI: 10.1016/j.transproceed.2019.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
AIM The diagnosis and management of multiple renal arteries and veins have gained importance with the increasing number of kidney transplantations and improved techniques in interventional radiology and vascular reconstructions. The aim of this study is to define and to detect the rate of multiple renal arteries and veins in our living kidney transplant donors coming from all parts of our country. METHODS Abdominal computed tomography angiogram findings of 878 kidney transplant donors were analyzed. The presence and the distribution of multiple renal arteries and veins in donors coming from 7 geographic regions in Turkey were noted. RESULTS The presence of multiple renal arteries was observed in 34% (48/141) of patients in the Marmara Region, 36.7% (79/215) of patients in the Black Sea Region, 37.2% (64/172) of patients in the Central Anatolia Region and 36.1% (30/83) of patients in the Southeastern Anatolia Region. The highest incidences of multiple renal arteries were observed in the Mediterranean and Aegean regions, affecting 40% (32/80) and 41.9% (26/62) of patients, respectively, while East Anatolia was found to have the lowest incidence, affecting 28% (35/125) of patients. The incidence of multiple renal veins also varied across regions. The highest incidence was observed in the Central Anatolia Region, where 23.3% (40/172) of patients were affected; the lowest was seen in the Aegean Region, where 11.3% (7/62) of patients were affected. In Turkey as a whole, 35.8% (314/878) of patients presented with multiple renal arteries, while the rate of multiple renal veins was found to be 19% (167/878) among our donors. CONCLUSIONS As 80% of the kidney transplantations performed in Turkey involve living donors, we think it will be useful to have knowledge of not only the presence of multiple renal arteries and veins, but also the distribution of this feature throughout the different regions of the country.
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Affiliation(s)
- U Cenal
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - T Erturk
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - A H Karayagiz
- Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - E Ozdemir
- Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - S V Polatkan
- Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - U Cakir
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - I Berber
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
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18
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Gulas E, Wysiadecki G, Szymański J, Majos A, Stefańczyk L, Topol M, Polguj M. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci 2018; 14:442-453. [PMID: 29593819 PMCID: PMC5868651 DOI: 10.5114/aoms.2015.55203] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 11/17/2022] Open
Abstract
Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.
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Affiliation(s)
- Ewelina Gulas
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Jacek Szymański
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Lodz, Poland
| | | | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Mohiuddin M, Manzoor A, Ali M, Hassan N. Analysis of renal artery morphometery in adults: A study conducted by using Multidetector computed Tomography Angiography. Pak J Med Sci 2017; 33:943-947. [PMID: 29067070 PMCID: PMC5648969 DOI: 10.12669/pjms.334.13063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To determine a reference range of renal artery measurements by using Multidetector Computed Tomography (MDCT) angiography and to find association of renal artery measurements with side of artery, gender and age. Method: Two hundred and fifty study participants without renal artery disease who werepresented to Radiology Department, Ziauddin Hospital, Karachi, from November, 2016 to April, 2017 were included in this study. Main renal artery measurements were taken on Multidetector computed angiography and variation with side, gender and age were analyzed. Statistical analysis was done on Statistical Package for Social Sciences (SPSS) version 20. Independent sample T test, one way ANOVA and Pearson’s correlation analysis were applied. P-value of < 0.05 was considered significant. Results: A significance difference (p=0.001) was seen between mean right renal artery (diameter 6.66 ± 0.39 mm; length 44.69 ± 2.48 mm) and left renal artery (diameter 6.79 ± 0.36; length 35.10 ± 2.86 mm). Females found to have smaller mean diameter and length of renal arteries than males. However, a weak negative correlation was seen between mean renal artery diameter and age (right r= -0.158, p=0.0121; left r= -0.017, p= 0.708). Conclusion: The mean diameter and mean length were found to be significantly different between right and left main renal artery and between males and females. A significant weak negative correlation was observed between renal artery diameter and age.
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Affiliation(s)
- Maria Mohiuddin
- Dr. Maria Mohiuddin, Senior Lecturer, Department of Anatomy, Ziauddin University, Hospital, Karachi, Pakistan
| | - Arsalan Manzoor
- Dr. ArsalanManzoor, Assistant Professor, Department of Anatomy, Ziauddin University, Hospital, Karachi, Pakistan
| | - Muhammad Ali
- Dr. Muhammad Ali, Assistant Professor, Head of Department of Radiology, Ziauddin University, Hospital, Karachi, Pakistan
| | - Nuzhat Hassan
- Prof. Dr. Nuzhat Hassan, Chairperson, Department Of Anatomy, Ziauddin University, Hospital, Karachi, Pakistan
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20
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Tardo DT, Briggs C, Ahern G, Pitman A, Sinha S. Anatomical variations of the renal arterial vasculature: An Australian perspective. J Med Imaging Radiat Oncol 2017; 61:643-649. [PMID: 28466967 DOI: 10.1111/1754-9485.12618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/11/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Variations of the renal arteries have been studied and published across various population groups, but similar information for the ethnically diverse nation of Australia is lacking. This study describes the pattern of renal artery anomalies in a section of the Australian population based on computed tomography (CT) angiograms of the abdomen and cadaveric dissection. METHODS The renal arterial vasculature of 594 kidneys from 300 subjects (28 cadavers, 272 CT) was studied. The number and pattern of renal arteries were categorised on the basis of laterality, point of origin and termination in the kidney (superior pole, hilum and inferior pole), symmetry and sex. RESULTS Multiple renal arteries were discovered in 22% of subjects and 12.12% of kidneys. The most common pattern observed was the presence of one variant renal artery (93.1%), compared to the finding of two (5.6%) and three (1.4%) multiple arteries. The aorta was the most frequent site of origin for anomalous vessels, while the hilum was the predominant point of entry. No significant difference was established between left- and right-sided kidneys (13.8% vs. 12.5%; P = 0.627); however, unilateral distribution was more common than bilateral additional renal arteries (16.7% vs. 3.4%; P < 0.01), and variations among males were more than females (27.2% vs. 15.2%; P < 0.05). A higher rate of multiple renal arteries was noted in cadaveric dissections compared to CT images (46.4% vs. 19.5%; P < 0.01). CONCLUSION These findings provide application of an evidence-based teaching tool that facilitates education regarding renal arterial variations in Australia.
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Affiliation(s)
- Daniel T Tardo
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,St George & Sutherland Clinical School, UNSW Medicine, Sydney, New South Wales, Australia
| | - Christopher Briggs
- Department of Anatomy and Neuroscience, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gerard Ahern
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,Department of Anatomy and Neuroscience, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Pitman
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,Department of Anatomy and Neuroscience, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiology and Nuclear Medicine, St John of God Hospital Ballarat, Ballarat, Victoria, Australia
| | - Sankar Sinha
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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21
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de Mello Júnior CF, Araujo Neto SA, de Carvalho Junior AM, Rebouças RB, Negromonte GRP, de Oliveira CD. Multidetector computed tomography angiography of the renal arteries: normal anatomy and its variations. Radiol Bras 2016; 49:190-5. [PMID: 27403020 PMCID: PMC4938450 DOI: 10.1590/0100-3984.2014.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Conventional angiography is still considered the gold standard for the study of the anatomy and of vascular diseases of the abdomen. However, the advent of multidetector computed tomography and techniques of digital image reconstruction has provided an alternative means of performing angiography, without the risks inherent to invasive angiographic examinations. Therefore, within the field of radiology, there is an ever-increasing demand for deeper knowledge of the anatomy of the regional vasculature and its variations. Variations in the renal vascular system are relatively prevalent in the venous and arterial vessels. For various conditions in which surgical planning is crucial to the success of the procedure, knowledge of this topic is important. The aim of this study was to familiarize the general radiologist with variations in the renal vascular system. To that end, we prepared a pictorial essay comprising multidetector computed tomography images obtained in a series of cases. We show patterns representative of the most common anatomical variations in the arterial blood supply to the kidneys, calling attention to the nomenclature, as well as to the clinical and surgical implications of such variations.
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Affiliation(s)
| | - Severino Aires Araujo Neto
- PhD, Adjunct Professor II of Clinical Radiology, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil
| | | | - Rafael Batista Rebouças
- MD, Urologist, Professor of Urology, Faculdade de Ciências Médicas da Paraíba, João Pessoa, PB, Brazil
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22
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Shigueoka DC. Anatomic variations of the renal arteries, as characterized by computed tomography angiography: rule or exception? Its usefulness in surgical plannning. Radiol Bras 2016; 49:VII-VIII. [PMID: 27777491 PMCID: PMC5073403 DOI: 10.1590/0100-3984.2016.49.4e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David C Shigueoka
- Adjunct Professor in the Department of Diagnostic Imaging at the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil. E-mail:
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23
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Gulas E, Wysiadecki G, Cecot T, Majos A, Stefańczyk L, Topol M, Polguj M. Accessory (multiple) renal arteries - Differences in frequency according to population, visualizing techniques and stage of morphological development. Vascular 2016; 24:531-7. [PMID: 26945775 DOI: 10.1177/1708538116631223] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to comprehensively analyze the literature focused on frequency of the presence of the accessory renal arteries in the human body. A systematic analysis of papers has been made. With regard to ethnicity, the incidence of accessory renal arteries fluctuates from 4% in a Malaysian population to 61.5% in a Brazilian population. The frequency is lowest in eastern and southern Asia (from 4% to 18.4%). In some, not ethnically homogenous populations, wide span of occurrence of accessory renal arteries is described (e.g. American - averaging from 18% to 28.8%). A higher frequency of accessory renal arteries was observed in fetuses compared to adults. Moreover, differences in the presence and number of accessory renal arteries reported in different papers are a consequence of type of visualizing technique used in research - especially when computed tomography and anatomical dissection were compared. The increasing number of surgical interventions, especially where laparoscopic methods are concerned, underlines the importance of such knowledge especially to surgeons, interventional radiologists, nephrologists, and vascular surgeons.
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Affiliation(s)
- Ewelina Gulas
- Department of Angiology, Medical University of Łódź, Narutowicza, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza, Poland
| | - Tomasz Cecot
- Centre for Learning Anatomical Sciences, University of Southampton, Great Britain
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, Żeromskiego, Poland
| | - Ludomir Stefańczyk
- Department of Radiology, Medical University of Łódź, Kopcińskiego, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza, Poland
| | - Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza, Poland
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24
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Schönherr E, Rehwald R, Nasseri P, Luger AK, Grams AE, Kerschbaum J, Rehder P, Petersen J, Glodny B. Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria. BMJ Open 2016; 6:e009351. [PMID: 26729385 PMCID: PMC4716171 DOI: 10.1136/bmjopen-2015-009351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. DESIGN AND SETTING In a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60 ± 17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies. RESULTS Among the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34 ± 11.4 mm (CI 32 to 36) vs 45.9 ± 15 mm (CI 43.2 to 48.6); p<0.0001), but had a slightly larger diameter (5.2 ± 1.4 mm (CI 4.9 to 5.4) vs 4.9 ± 1.2 mm (CI 4.6 to 5.1); p>0.05). The first left renal arteries were 1.1 ± 0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3 ± 0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p<0.05). Ostial funnels were up to 14 mm long. The cross-sections were elliptical, more pronounced on the right side (p<0.05). In 23 cases (18.3%), the main artery was shorter than 2 cm; in 43 cases (34.1%), the diameter was not >4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation. CONCLUSIONS Based on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates.
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Affiliation(s)
- Elisabeth Schönherr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Rafael Rehwald
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Parinaz Nasseri
- University Clinic of Oral and Maxillofacial Surgery, Salzburg General Hospital, Salzburg, Salzburg, Austria
| | - Anna K Luger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Astrid E Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Julia Kerschbaum
- Department of Internal Medicine IV, Nephrology and Hypertensiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Peter Rehder
- Department of Urology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Johannes Petersen
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
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Eligibility for Renal Denervation: Anatomical Classification and Results in Essential Resistant Hypertension. Cardiovasc Intervent Radiol 2014; 38:79-87. [DOI: 10.1007/s00270-014-0865-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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