English

Abstract

The renal vasculature was always a subject of variations both in the number and pattern of portal of entry into kidney and Perihilar placement of the artery, vein and pelvis. Good anatomical insight is an essential prerequisite besides the surgical expertise. The cadaveric dissection revealed a Right Kidney supplied by Quadruple renal arteries & Drained by two renal veins. The main renal artery (MRA) was arising from antero lateral aspect and the accessory renal artery was arising from anterior aspect of aorta 1cm distal to the former vessel. Only the MRA showed Fork Pattern Branching with four anterior segmental arteries and one posterior segmental artery in the pre hilar region. The first and fourth segmental arteries showed a small subsidiary branch and a large tortuous subsidiary branch respectively. The later along with the branch running downwards and lateral from lower renal artery formed a common trunk and pierced the capsule and entered into the substance of the kidney anteriorly about 2cm lateral to the hilum, thus forming an aberrant artery. The upper polar artery was seen arising from the lower supra renal artery. The main renal vein (MRV), was formed by two formative tributaries of which one is larger and other being smaller. The later was seen just anterior to the third anterior segmental branch of MRA. Accessory renal vein was formed by only one tributary encircled by the fourth anterior segmental artery and posterior segmental artery. There was crowding of structures seen with altered hilar anatomy in both vertical and horizontal disposition. Such a rare combination of extra renal multiple arterio-venous variation is of worth concern to the urologists harvesting kidneys from the live donors for performing transplantation procedures. Partial nephrectomies for the hilar tumors and for Radiologists during interpretation of the angiograms.