Anatomical variations of the renal arteries: Cadaveric and radiologic study, review of the literature, and proposal of a new classification of clinical interest

Cases, Clara; García-Zoghby, Laura; Manzorro, Paula; Valderrama-Canales, Francisco J.; Muñoz, M. Duque; Vidal, María; Simón, Clara; Sañudo, José Ramón; McHanwell, Stephen; Arrazola, Juan

doi:10.1016/j.aanat.2017.01.012

Cited by 27 publications

(18 citation statements)

References 21 publications

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“…Renal vasculature is in centre of scientific interest for long time [ 27 ] and is well described [ 1 , 3 , 13 , 31 ]; however, previous analysis should be revised because along with post-mortem examinations [ 19 ] new techniques were adapted [ 10 , 30 ]. Despite some attempts in this matter, vascular network of horseshoe kidney has still not been fully described, primarily due to its considerable variability [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study

et al. 2018

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PurposeHorseshoe kidney is a rare congenital anomaly with potential clinical implications. The aim of this study was to determine the number of renal arteries and veins and the level at which the arteries branched off their parental vessels in individuals with horseshoe kidney (HSK) and in persons with separated kidneys (SK).Materials and methodsThe analysis included computed tomography angiography studies of 331 patients (83 HSK and 248 SK). The number of renal vessels and diameters of renal arteries were determined, along with the level at which they branched in relation to other ramifications (four groups of origin were proposed) and their entrance of the vessels to the kidney.ResultsNumber of renal arteries in HSK group was 4.57 ± 1.39 per patient and 2.4 ± 0.43 in SK group (p < 0.0001). The distribution of branching level of renal arteries in HSK group was: I group ~ 57%, II group ~ 27%, III group ~ 15% and IV group < 1%, whereas in SK group the distribution was respectively: I group ~ 99%, II group < 1%, III and IV group − 0% (p = 0.0001). In HSK group, diameter of renal arteries branching above the IMA was 4.61 ± 1.58 mm, as compared with 3.96 ± 1.34 mm for the arteries branching below (p = 0.0004). Number of veins was 566 in SK group (87.70% of kidneys were supplied by single vein) and 323 in HSK group (9.64% kidneys were supplied by two veins) (p < 0.0001).ConclusionIn HSK group, renal arteries significantly more often branch off their parental vessels below the origin of IMA and such vessels are usually smaller.

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Section: Introductionmentioning

confidence: 99%

The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study

et al. 2018

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“…This is evidenced by the numerous scientific studies in which the morphological features of the renal arteries have been analyzed, either in cadavers or by a variety of imaging techniques such as ultrasonography, classical angiography, computed tomography (CT) or magnetic resonance imaging [ 3 , 5 , 9 , 10 , 16 ]. These studies have predominantly focused on analyzing variant renal artery anatomy with an emphasis on the presence of accessory arteries [ 4 , 7 , 13 , 22 ]. The level of renal artery origin, vessel length, level at which branching occurs, and point of entry into the kidney have all been analyzed as potential parameters.…”

Section: Introductionmentioning

confidence: 99%

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries

et al. 2017

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BackgroundAn in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries.Materials and methodsComputed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply.ResultsThe frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219).ConclusionsThe classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.

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“…There are several anatomical variations of the renal arteries, with an aortic lower polar artery found in 3% of cadavers and 1% of patients on CT, more frequently on the right side. 3 Renovascular hypertension 4 secondary to an injury of an accessory polar renal artery (APRA) has also been described. Although vascular anomalies, especially venous ones, are more frequently found at the infra-renal left level, in this video we show access to the right side of the dissection and the care that needs to be taken in order not to damage a vascular structure at this level.…”

Section: Discussionmentioning

confidence: 99%

Accessory polar renal artery not pre-operatively visualized at extra-peritoneal para-aortic lymphadenectomy

Madsen

Gorostidi²,

Ruiz

et al. 2019

Int J Gynecol Cancer

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The objective of this video is to describe the technique of extra-peritoneal para-aortic laparoscopic lymphadenectomy and emphasize potential vascular risks that should be taken into account during the procedure.The procedure was performed at Donostia University Hospital, a tertiary referral and educational center in San Sebastián, Spain.A 58-year-old woman, body mass index 25.4 kg/m2, G2P2, with a diagnosis of intermediate-risk endometrial adenocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) IBG2 based on pre-operative endometrial histology and pre-operative magnetic resonance imaging (MRI), but upstaged to high-risk endometrial adenocarcinoma on final report (IBG3). In our hospital, risk stratification is based on pelvic MRI (myometrial invasion, cervical invasion) and biopsy (histology and grade) to tailor surgery. Computed tomography (CT) scan pre-operatively is only performed for type 2 endometrial carcinoma and grade 3 histologies.The local institutional review board was consulted, which confirmed that the study was exempt from requiring approval.The patient underwent an extra-peritoneal para-aortic laparoscopic lymphadenectomy, trans-peritoneal bilateral pelvic lymphadenectomy, and a total hysterectomy and bilateral salpingo-oophorectomy.It is mandatory to check pre-operative imaging studies in order to identify vascular anomalies that are not uncommon and may increase the risk of vascular complications.1 Frequently these vascular anomalies, such as a retro-aortic left renal vein, or a double vena cava or left vena cava, may be a casual finding in the pre-operative study, and often such findings are not reported by the radiologist. It is vitally important that the surgeon checks for and identifies any such anomolies, as the risk of complications may be decreased if anomalies of this type are detected pre-operatively.In addition, in the case of existing polar renal arteries, these are frequently not identified in the pre-operative study,2 leading to a risk of injury and partial renal necrosis. There are several anatomical variations of the renal arteries, with an aortic lower polar artery found in 3% of cadavers and 1% of patients on CT, more frequently on the right side.3 Renovascular hypertension4 secondary to an injury of an accessory polar renal artery (APRA) has also been described.Although vascular anomalies, especially venous ones, are more frequently found at the infra-renal left level, in this video we show access to the right side of the dissection and the care that needs to be taken in order not to damage a vascular structure at this level. Special caution is required with the right side of the dissection so as not to injure any perforating veins, including Fellow's vein, when pushing all the nodes to the roof of the dissection.The dissection maneuvers are fine and blunt, establishing bridges of tissue to be sectioned, and thus identifying vascular structures, such as a right APRA that is to be identified and preserved.The surgeon must have a good knowledge of retro-peritoneal vascular anatomy, they should examine pre-operative imaging studies to check for vascular anomalies, and they need to possess an accurate surgical technique to avoid potential vascular injury during laparoscopic para-aortic lymphadenectomy.

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Anatomical variations of the renal arteries: Cadaveric and radiologic study, review of the literature, and proposal of a new classification of clinical interest

Cited by 27 publications

References 21 publications

The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study

The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries

Accessory polar renal artery not pre-operatively visualized at extra-peritoneal para-aortic lymphadenectomy

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