Ectopic Vascularization of the Right Kidney by a Contralateral Origin of the Main Renal Artery from the Left Common Iliac Artery: Report of a Case

Abstract

In daily practice, an atypical renal blood supply is a rare finding. An ectopic origin of the right main renal artery from the contralateral common iliac artery was observed when angiography was performed to diagnose irregularities in perfusion of the lower extremities and to determine the necessity for vascular surgical intervention in a 66-year-old man. Conservative treatment was successful in this patient, who suffered from intermittent claudication because of an obstruction of the superficial femoral arteries. The diagnostic approach with angiography is considered to be essential for revealing such anomalies. Conventional vascular surgical reconstruction would have threatened the perfusion of the right kidney in this case.

Bilateral quadruple renal arteries

“…Most organs “trail” their blood supply as they migrate (Cochard,2002). Embryologically, the urinary excretory organs develop in three stages: the pronephros (primitive stage), the mesonephros (transitory kidney), and the metanephros (the permanent kidney; Felix,1912; Garti and Meiraz,1980; Halloul et al,2001).…”

“…The mesonephros , located from the sixth cervical to the third lumbar segment (Felix,1912), supplied by temporary aortic branches from same level (Graves,1969; Garti and Meiraz,1980; Halloul et al,2001) contains functional primitive glomeruli (Cocheteux et al, 2001) . They are developed on each side in maximo 30 mesonephric arteries (temporary aortic branches), which are distributed throughout the entire mesonephric area (at first they are entirely distributed to the mesonephros, but later they also supply the reproductive glands, the suprarenal bodies, the metanephros, and the diaphragm); these new regions of distribution prevent their complete degeneration when the mesonephros disappears (Felix,1912), namely at the end of the eight week.…”

“…This network comes into connection with vessels, which actually enter the renal sinus; in this method, the vessels of the metanephros become connected with the mesonephric arteries and through them with the aorta. It then normally discards all, but one of its mesonephric branches enlarged, and the remaining artery at the L2 level becomes the permanent main RA (Garti and Meiraz,1980; Halloul et al,2001). During the transition phase from mesonephros to metanephros, if more than one mesonephric arterial branch persists, it results the additional RAs (Bayazit et al,1992; Halloul et al,2001; Lacout et al,2012).…”

“…Rossi et al (2006) reported a case of seven RAs (four left RAs and three right RAs; two main RAs and five AdRAs). Kinnunen et al (1985) reported a subject with 10 RAs. The prevalence of one, two, or more AdRAs has been reported to be 17.6, 2.3, and 1%, respectively (Kruyt,1992).…”

Main right renal artery originating from the superior mesenteric artery

“…There have only been two such anatomical variants of RRA arising from the MSA reported, at autopsy (Dalçik et al,2000; Bamac et al,2011). Other ectopic anatomical variants include a main RRA originating from the right or the left common iliac artery (Halloul et al,2001; Kotsis et al,2007) and from the inferior mesenteric artery (Garti et al,1986). Other ectopic origins of the renal artery have been reported such as the celiac trunk (Garti and Meiraz,1980) and the splenic artery on the left side (Kruyt,1992).…”