The applied anatomy of vascular variability of duplex kidney in children

Abstract

Objective To study the vascular anatomy of duplex kidney and to provide a scientific basis for surgical resection of the renal segment. Methods From February 2012 to April 2018, the clinical data of 84 children with renal duplex kidney disease admitted to our hospital, were reviewed and analyzed. Among them, 75 cases (89.3%) were unilateral and 9 cases (10.7%) were bilateral. According to the preoperative CT+ CTA and the duplicated renal morphology, size, location, and anatomical relationship of the kidney segment, combined with the branches and passage of the renal artery which supplies the upper moiety, it described the blood supply of the upper renal moiety. At the same time, it analyzed various types of embryological related factors and gender differences and summarized the tips for laparoscopic surgery. Results Of the 93 duplex kidneys, 69 (74.2%) were supplied with 1 artery, and 25 (26.9%) were supplied with 2 or more arteries. Based on the shape and orifice of artery, they were divided into 3 types. The most common type was that the renal artery separated into two or more arteries near the renal parenchyma. The upper and lower renal poles were respectively supplied, which could be summarized as early branching, a total of 71 sides (76.3 %). The second type was the arteries from abdominal aorta or its branches, directly flowing into the upper renal pole, which was classified into the sub-renal artery, a total of 18 sides (19.4%). The others (4 sides, 3.3%) were less common, and most of them were a combination of the above-mentioned two types, and one of them whose upper pole was supplied by branches of adrenal artery. Based on the classification of vascular variability, no significant difference was found between males and fenmals, or left and right sides. Conclusions The upper renal moiety are mainly supplied by one branch of renal artery, and the most common type of this artery is prehilar branch, without gender difference. The determination of vascular variability before surgery can avoid bleeding during surgery and avoid accidental injury of normal blood vessels. Key words: Duplex kidney; Vascular anatomy; Laparoscopic surgery