Variant anatomy of the renal arteries with anastomosis variants in kidney transplantation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. One of the most important tasks of morphology as an integral part of practical medicine is comprehensive development of theoretical knowledge pertaining to the variants and anomalies of the renal arteries anatomy. One of the main conditions required for the normal functioning and viability of the renal transplant is its adequate perfusion. Due to the variant anatomy of the renal arteries and the presence of several adjacent vessels with which anastomosis can be performed, there are many strategies for arterial allograft anastomosis. The goal of the study was to identify patterns of variant topography and anatomy of the human renal arteries according to CT angiography with three-dimensional modeling which would be further used to optimize the technique of forming vascular anastomosis during kidney transplantation. Materials and methods. The study included an assessment of computed tomograms of the abdominal organs of 130 patients, which were used to build three-dimensional models. Morphometry was carried out using the Autoplan and Luch-S programs. Based on the results of the CT scans of the kidneys and renal arteries in patients who underwent kidney transplantation, computer 3D models of the renal artery and arterial renal bed were constructed when anastomoses of the renal artery were performed with: the external iliac (group I), the internal iliac (group II) and common iliac (group III) arteries, and in the cases of multiple arteries - during the formation of a common trunk (IIa subgroup) or separate anastomosis with the common iliac artery (IIb). Afterwards, using the Abaqus program, analysis of hemodynamic parameters of intravascular blood flow was conducted, namely: volumetric blood flow rate, partial renal blood flow (the ratio of volumetric blood flow rate to graft weight), visual assessment of the blood flow turbulence. Results volumetric renal blood flow in group II (594 cm3/min) and group III (610 cm3/min) was greater than in group I (550 cm3/min); specific renal blood flow in group III exceeded groups I and II by 0.34 cm3/min/g; high turbulence was observed in the anastomosis angle region in groups I and III. The volumetric renal blood flow in subgroups IIa and IIb was 615 and 585 cm3/min respectively, and in the presence of an extra artery extending from the lower pole, a decrease in the linear blood flow velocity in the inferior polar segmental artery was visually assessed. Based on the results of the study, we can conclude that in the presence of a single renal artery, the best perfusion outcome is achieved when performing anastomosis with the common and internal iliac arteries. With multiple kidney arteries, the best perfusion option is obtained when a single renal artery fistula is formed.