Multidetector computed tomography angiography of the renal arteries: normal anatomy and its variations

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.

Analysis of renal artery morphometery in adults: A study conducted by using Multidetector computed Tomography Angiography

“…It is essential for the radiologists and surgeons to have background knowledge of normal range of renal artery measurements and variation in measurementsin a specific population as this can affect complex and expertise required procedure. 23 , 24 In our study a significant difference was observed between mean diameter of right and left main renal arteries. Mean diameter of right renal artery was found to be smaller than mean diameter of left renal artery.…”

Anatomic variations of the renal arteries, as characterized by computed tomography angiography: rule or exception? Its usefulness in surgical plannning

“…Finally, Mello Júnior et al ( 2 ) provided practical recommendations for the interpretation of CT angiography of the renal arteries, guiding the detailed description, plus measures, which promotes greater consistency in communicating the findings to the surgeon, as previously suggested by other authors ( 15 ) .…”

“…In his Traité d'Anatomie Humaine , the classical anatomist Testut noted that "the kidneys, as well as other organs that perform important functions, have an extremely rich and complex vasculature" ( 1 ) . In the previous issue of Radiologia Brasileira , Mello Júnior et al ( 2 ) described the normal appearance of the renal arteries and their most common anatomical variations, as observed with computed tomography (CT) angiography. The authors also discussed the technical aspects of implementing CT angiography, the post-processing of images, and the terminology involved, as well as the clinical and surgical implications.…”

“…Mello Júnior et al ( 2 ) also underscored the importance of characterizing any accessory inferior polar artery in the surgical treatment of stenosis at the ureteropelvic junction (UPJ). Although the polar artery is not always the cause of obstruction, its identification is useful in surgical planning, particularly when the procedure will be endoscopic, in which the long longitudinal incision made over the UPJ can injure any vessel in its path, laparoscopic pyeloplasty being an alternative when a polar artery is identified ( 11 ) .…”

“…The nomina anatomica in Portuguese is silent on the topic of these structures. Mello Júnior et al ( 2 ) recommended the Portuguese-language terminology proposed by Sampaio et al ( 13 ) and employed by Palmieri et al. ( 14 ) , both of whom conducted studies in Brazil and who used (the equivalents of) the denominations hilar artery, (superior and inferior) extra-hilar artery, (superior and inferior) polar artery, and early bifurcation, as well as providing a detailed description of each.…”