Double Renal Arteries Research Articles

The early outcomes of two separate anastomosis procedures in deceased kidney transplantation with double arteries: A retrospective comparative study

BackgroundKidneys with double renal arteries are used on a routine basis nowadays, and separate anastomosis in situ is one of the suitable arterial anastomosis procedures. The commonly used methods are parallel end-to-side anastomoses of double arteries to the external iliac artery, and end-to-end anastomosis to the internal iliac artery combined with end-to-side anastomosis to the external iliac artery. No studies have compared the prognoses of the two procedures in deceased kidney transplantation. MethodsWe retrospectively analyzed 35 consecutive deceased kidney transplantations with double arterial anastomoses in the urology department of China–Japan Friendship Hospital from January 2018 to April 2021. Group I comprised recipients with double parallel end-to-side anastomoses to the external iliac artery; Group II comprised the others. Their prognoses were then compared. ResultsThere were no significant differences between Group I and II in characteristics of recipients and donors. The mean eGFRs at 1, 3, 6 and 12 months post-transplant in Group I and II were 36.4 vs 54.1 (P = 0.009), 40.4 vs 54.4 (P = 0.02), 40.4 vs 56.9 (P = 0.02) and 39.8 vs 57.9 (P = 0.007) mL/min respectively. There was no difference in early postoperative complications and 1-year survival rates between the two groups (P = 1.00). ConclusionSeparate anastomosis is a reliable procedure for deceased kidney transplantation with double arteries. Double separate anastomoses to the external and internal iliac arteries have better graft function compared with double parallel anastomoses to the external iliac artery during the first year after transplantation.

Multicentre Experience with Novel Bidirectional Double Cuffed Inner Branches for Complex Endovascular Aortic Repair

This study aimed to report the initial experience with a novel bidirectional double cuff inner branch design for incorporation of renal and mesenteric arteries in patients undergoing fenestrated and branched endovascular aortic repair (F/BEVAR). A retrospective review was undertaken of the experience of F/BEVAR with grafts integrating at least one bidirectional double cuffed inner branch implanted at three tertiary aortic centres between March 2022 and June 2023. All consecutive patients were included. Baseline characteristics, operative data, and follow up data were collected. Results were presented as number or median (interquartile range) unless otherwise stated. Thirteen patients (10 male; median age 72 [68, 77] years) had F/BEVAR using a total of 15 bidirectional double cuffed inner branches (30 cuffs). Indications for bidirectional doubled cuffed inner branches included cranial vessel orientation or double renal arteries in four patients each, common coeliomesenteric trunk in three patients, and early renal artery bifurcation, renal artery origin from a false lumen requiring a flexible route for catheterisation, and surplus configuration in one patient each. Twenty three of the 30 cuffs were used, whereas the remaining seven cuffs were intentionally occluded with vascular plugs. Target vessel incorporation was successful in all bidirectional branches. There was one technical failure related to unsuccessful catheterisation of a left renal artery targeted through a unidirectional caudal inner branch. During a median follow up of seven months there were no instances of target vessel instability or re-interventions and two patients died of causes unrelated to the bidirectional branches. The results of the use of bidirectional double cuff inner branches are promising, with high technical success and no short term branch related complications in this preliminary experience. This could potentially expand the applicability of branch endografting of complex endovascular aortic repairs, but long term results are still missing.

A report on accessory renal arteries incidence in Slovak adults: Cadaveric study and surgical correlation

The aim of the study was to evaluate renal arterial variations in Slovak context. Forty cadavers (80 formalin-fixed cadaveric kidneys) were included in the study. The accessory renal arteries (ARAs) were evaluated on the basis of point of origin, termination in the kidney (superior pole, hilum, inferior pole), and symmetry. The incidence of ARAs was detected in 20 % (8/40) of the cadavers. Double renal arteries were observed in 9 (11.25 %, n = 80) of kidneys. Among 8 cadavers with ARAs, the unilateral presence of ARA was found in 7 cadavers and bilateral presence in 1 cadaver. Among 9 ARAs, polar artery was the most common anomaly seen in 7 (78 %) kidneys (inferior polar artery 5, superior polar artery 2) followed by the hilar artery in 2 kidneys. This is the first cadaveric study on the incidence and morphology of ARAs in Slovakia. The study has shown that the variations in renal arterial anatomy are afrequent finding (20 % of cadavers) while all of the described variants have significant implications for avariety of surgical procedures in the retroperitoneal space. The variations in renal arteries should be considered an integral part of anatomy teaching as they point to the diverse clinical reality of anatomy (Tab. 1, Fig. 1, Ref. 35). Text in PDF www.elis.sk Keywords: renal artery, variation, polar artery, double renal artery, cadaver.

Variations in Renal Arteries- A Cadaveric Study in Telangana, India

Introduction: Regarding the disorders associated with multiple renal arteries, they are of specific interest to urologists, nephrologists, surgeons, and radiologists. Aim: To identify the presence of multiple renal arteries in the human cadavers. Materials and Methods: An observational cadaveric study was conducted on 50 formalin-fixed human cadavers in Osmania Medical College, Hyderabad, Telangana, India, from May 2017 to July 2022. Dissection procedure was followed according to standard techniques. Variations and patterns of renal arteries were observed. Descriptive statistics were used and results were expressed in terms of frequency (N) and percentages (%). Results: Out of 50 cadavers, variations in the renal artery were seen in eight cadavers. Four cadavers showed double renal arteries (one right side and three left side). Three cadavers showed early division and one cadaver which has shown double Right Renal Artery (RRA) also showed Early Division of RRA (ED of RRA) and one cadaver showed an Accessory Renal Artery (ARA) on the left side. Conclusion: Variations observed were mainly double renal arteries, early division of the renal arteries, and ARA. This kind of different pattern of variations may play an important role in renal transplants and any surgeries involving the renal arteries.

Bilateral Duplication of Renal Artery in a Cadaver and Its Clinical Implications: A Case Report

In normal adult renal system, the renal artery originates from the abdominal aorta at the level of the lower border of L1 vertebrae, just below the origin of the superior mesenteric artery, one on each side. In 15-30% of the population, rare variation in origin and distribution pattern of renal artery can be seen. These variations may be attributed to anomalies in the development of the vascular system. These anomalies lead to the emergence of accessory or multiple renal arteries, causing significant variations in normal anatomical pattern. The aim of present study was to report the presence of double renal arteries on both sides, which has about 10% occurrence amongst all renal artery variations. Most commonly, double arteries are found unilaterally in approximately 30% of cases. Also, in the present case, the renal system was perfused by additional prehilar branches and polar arteries arising from either of the renal arteries. Hence, it is a rare entity. The occurrence of such variation in the vasculature of renal arteries has significant clinical implications. The knowledge of presence of aberrant or multiple renal arteries is significant for urologists, physicians, radiologists and surgeons, while performing surgeries related to kidneys, adrenal glands and associated structures.

Laparoscopic Radical Nephrectomy in the Current Era: Technical Difficulties, Troubleshoots, a Guide to the Apprentice, and the Current Learning Curve.

Abhishek Pandey, MSObjectives The main aim of this study is to present our experience with laparoscopic radical nephrectomy (LRN) and share practical solutions to various surgical challenges and the learning curve we realized. Materials and Methods We retrospectively analyzed our LRN database for relevant demographic, clinical, imaging, operative, and postoperative data, including operative videos. We described various complications, vascular anomalies, intraoperative difficulties, and our improvisations to improve safety and outcomes. Statistical Analysis We evaluated the learning curve, comparing the initial half cases (group 1) against the latter half (group 2), using the chi-squared test for categorical variables and Student's t -test for continuous variables. Results Of the 106 patients included, LRN was successful in 95% ( n = 101), and five cases converted to open surgical approach. The mean tumor size was 7.4 cm, 42% incidentally detected. The cumulative complication rate was 15%, including five main renal vein injuries. Intraoperative difficulties included ureter identification ( n = 6), venous bleed during hilar dissection ( n = 11), double renal arteries ( n = 23), and venous anomalies ( n = 20). Arterial anatomy had 95% concordance with the imaging findings. We describe various trade tricks to perform hilar dissection, identify and control anomalous vasculature, handle venous bleed, confirm arterial control, and improve decisions using imaging, technology, and guidance of a mentor. No statistically significant difference in the learning curve was observed between the study groups. Conclusion With LRN already established as the current standard of care, our description intends to share the trade tricks and inspire novice urologists, who can assimilate training and reproduce good results under proper guidance. The steep learning curve described in the past may not be apparent in the current era of training and technological advancement.

Evaluation of renal vasculature and its variants by CT angiography

Background: Kidneys are a pair of retroperitoneal organs supplied by a single renal artery and vein. However, the classic illustration of the renal vasculature, formed by one renal artery and one renal vein, occurs in ≤25% of cases. MDCT angiography is presently the most preferred investigation for assessing prospective renal donors. Aims and Objectives: This study aims to familiarize urologists with the variations found in the renal vascular system, emphasizing prevalence, the adequate, appropriate terms, and the clinical and surgical implications involved. Materials and Methods: A cross-sectional study in 50 patients clinically indicated to undergo CT Renal angiographic study over 2 years is included in the study. This study was carried out to look for any anatomical variants in renal vasculature. CT examination was performed on a multidetector 16 slice CT Siemens scanner in the department of radiodiagnosis. Once conventional CT is done, the data obtained can produce 3D post-processing images that simulate conventional angiograms. Results: Out of 50 patients, single renal arteries are present in 27, and multiple renal arteries are present in 23 patients. Out of 27 patients with single renal arteries, 22.2 % has perihilar arterial branching. The most common variant was accessory renal arteries, which are found in 56% of individuals, followed by aberrant renal arteries found in 30% of individuals. Double renal arteries are found in 8.7% and triple renal arteries in 4.3% of cases. Out of 50 patients, 48 patients have a single renal vein, whereas two patients have supernumerary veins. The present study found right renal vein duplication in only 2% of patients. Conclusion: Renal arteries and veins show numerous variations in their origin sites, numbers, course, and division patterns. These variants exist in the population with high prevalence and are thus crucial in preoperative and intra-operative analysis for better prognosis and reduced complications. Preoperative CT evaluation of renal vasculature using MDCT angiography helps depict the presence or absence of renal arterial and venous variants.

Incidence of transplant renal artery stenosis (TRAS) and graft characteristics in renal transplant recipients with multiple renal arteries: A prospective observational study

Background: This was a prospective observational study to evaluate the incidence of Transplant Renal Artery Stenosis (TRAS) and Graft characteristics in Renal Transplant Recipients with Multiple Renal Arteries. Material andMethods: In the present study 25 patients’ recipients of multiple renal artery graft kidney who underwent renal transplant after 30 the June 2016 till October 2017 with post-transplant serum creatinine ≤ 1.5mg/dl were included and evaluated for stenosis by CT Angiography done after period of 90 days. Results: In this study double renal artery was present in 96% patients and triple renal artery was present in 4% of patients. Only left laparoscopic donor nephrectomy was done in all the cases. Arterial reconstruction was done by three techniques – double barreling done in 48% of cases, Y graft in 20% of cases and end to side anastomosis to main renal artery in 32% cases. Reconstructed renal artery was anastomosed to recipient external iliac artery by end to side anastomosis in 24% of patients and recipient internal iliac artery by end to end anastomosis in 76% of cases. Loupe was used during surgery in 28% of cases. Atheroma was present in 4% of donor vessels and 4% of recipient vessels. There was no technical difficulty in positioning of kidney in any of cases. There was incidence of delayed graft functioning in 8% of cases. There was no evidence of TRAS in any of cases on CT Angiography. There was no evidence of contrast induced nephropathy in this study group. Conclusion: In conclusion, there was no evidence of TRAS was found in any case. Hence no association could be established between occurrence of TRAS and various factors in patients with multiple renal artery live donor transplants with reconstruction.

Polycystic Kidney with Gross and Histological Aspects: A Case Report

Renal cysts are fluid-filled cavities on the surface of kidneys which may be solitary or multiple. They may present as incidental finding during routine radiological investigations for chronic renal failure, end-stage renal disease or due to associated abdominal symptoms. During routine cadaveric dissection at the Institute, multiple cysts were observed on the surface of left kidney in a 67-year-old male cadaver. The cysts were carefully observed for gross appearance and histological examination of the cysts and biochemical analysis of cystic fluid was done. The right kidney was normal in gross appearance but was associated with double renal arteries. The left kidney, which appeared smaller, showed polycystic appearance with total 14 cysts on the surface of left kidney and distorted histology. Knowledge of renal cysts and variations in renal vascular anatomy should be kept in mind for planning effective treatment.

Prevalence and Relevance of Multiple Renal Arteries: A Radioanatomical Perspective.

Background: A single renal artery supplies the kidney in 70% of the population but variation exists in the remaining 30%. Multiple renal arteries (MRA) in different permutations and combinations are one of the many forms of variants. Lack of awareness of multiplicity could have detrimental effects on the outcome of renal surgery. The present study aims at identifying the variants of renal artery based on its origin, multiplicity, and portal of entry in a cohort of people belonging to Southern India and its clinical implications thereof.Methods: Multi-detector CT (MDCT) images of renal vasculature of 100 kidneys from 50 live kidney donors who attended the Department of Nephrology of our institution, from 2016 to 2018 were collected and studied for variations in renal arterial anatomy.Results: Out of the 18% of kidneys observed with multiple renal arteries, 88.8% had double renal arteries (DRA) and 11.1% had triple renal arteries (TRA). Common types of the double renal arteries were - two hilar arteries (31.3%) and one hilar with one inferior polar artery (IPA, 31.3%). Triple renal arteries types - 50% with one hilar, one superior polar, and one inferior polar; 50% with two hilar and one inferior polar artery. No statistically significant association was noted between the incidence of multiple renal arteries and its laterality (p-value=0.193).Conclusion: A thorough understanding of the renal artery variants is crucial for safe and efficacious uro-radiological interventional procedures.

Application of computed tomography angiography in thoracic aortic aneurysm

Thoracic aortic aneurysm (TAA) is the most common thoracic aortic dilatation. Computed tomography angiography can effectively assess the shape, location and degree of dilatation of TAA. It can also show the blood vessels involved in TAA, including left subclavian artery, double renal artery and abdominal aorta. At present, post-processing techniques of computed tomography angiography include MPR, CPR, VR. These methods are commonly used to evaluate TAA.

1075 - Live related kidney transplantation in double renal arteries: Is 70/30 percent luminal discrepancy the new cutoff for Pajama bench reconstruction?

1075 - Live related kidney transplantation in double renal arteries: Is 70/30 percent luminal discrepancy the new cutoff for Pajama bench reconstruction?

Evaluation of the Renal Arteries of 2,144 Living Kidney Donors Using Computed Tomography Angiography and Comparison with Intraoperative Findings

Objectives: A carefully chosen and suitably prepared kidney donor is essential in living-donor kidney transplantation. Computed tomography angiography (CTA) is an effective imaging method for evaluating the renovascular morphology of donor candidates. The aim of this study was to evaluate renal artery variations in kidney donors using CTA and compare the findings with the number of arteries detected during laparoscopic donor nephrectomy. Materials and Methods: The study included 2,144 living donors who underwent pretransplant renovascular assessment using CTA and laparoscopic donor nephrectomy in our center between August 2012 and October 2018. The number of renal arteries to the donor kidney detected on CTA was compared with the number of arteries discovered intraoperatively. Results: The mean age of the 2,144 living kidney donors included in the study was 47.19 ± 13.3 (18–87) years. According to CTA findings, 81.1% (n = 1,738) had a single renal artery, 17.2% (n = 369) had double renal arteries, 1.6% (n = 35) had triple renal arteries, and 0.1% (n = 2) had quadruple renal arteries. The same number of renal arteries were detected by CTA and in laparoscopic donor nephrectomy in 97.9% (n = 2,099) of the donors. In the other 2.1% (n = 45), fewer renal arteries were detected intraoperatively compared to their CTA findings. None of the donors included in the study had a greater number of renal arteries discovered during nephrectomy than by CTA. Conclusion: CTA is a highly accurate method for the evaluation of renovascular variations in donor candidates for living-donor kidney transplantation. However, it must be kept in mind that double or multiple renal artery variations may be detected on CTA in 18.9% of donor candidates.

Management of donor kidneys with double renal arteries with significant luminal discrepancy: A retrospective cohort study.

Introduction:Side-to-side pantaloon anastomosis for renal grafts with double renal arteries (RA) with significant luminal discrepancy between graft arteries has not been reported. We hypothesized that the pantaloon technique is feasible and safe in these cases.Materials and Methods:A retrospective review of all consecutive, open, live-related renal transplants with double RA with significant luminal discrepancy performed at our center from January 2014 to September 2018 was undertaken. Significant luminal discrepancy was defined as smaller RA constituting 30% ± 5% of total RA diameter on preoperative computed tomography angiogram. Three groups were defined: Group A - pantaloon anastomosis, Group B - end-to-side anastomosis of smaller to main RA, and Group C - separate implantation of each artery. The primary objective was to study feasibility and safety of pantaloon anastomosis measured by recipient serum creatinine levels, Doppler ultrasound, and vascular complications (vascular thrombosis and anastomotic bleed). Secondary objectives included measurement of cold ischemia time, warm ischemia time in recipient (WIR), and nonvascular recipient complications.Results:Fifty-eight recipients had donors with double RA with significant luminal discrepancy. Group A - included 40, Group B – 5, and Group C - 13 patients. Recipient creatinine at day-7, - 30, and - 90 were similar among the groups. The 30-day perioperative complication rate was also similar. Group A and B had significantly lower WIR and higher cold ischemia time compared to Group C.Conclusion:Pantaloon anastomosis is feasible in renal grafts with double RA with significant luminal discrepancy and offers advantage of lower WIR compared to separate implantation technique.

Ectopic pelvic kidney and its renal artery from the common iliac artery

The pelvic kidney is the most common type of renal ectopia. It is clinically asymptomatic in general but are more prone to the urinary infections. It has also been associated with an increased risk of nephrolithiasis. The 37-year-old man was admitted to the emergency room with complaints of left flank pain, nausea and vomiting. In addition to this flank pain, the patient had an intermittent pain in the lower abdomen and pelvic region for 6 years with no history of fever. The renal ultrasound demonstrating several shadowing echogenic areas consistent with nephrolithiasis in both kidneys. In addition, while the right kidney was in the normal size and location, the left kidney was located on the ectopic site, just above the bladder. Doppler examination revealed double renal arteries originating from the aorta on the right side. Our case indicates the importance of the ectopic pelvic kidney location when planning surgical procedures in patients with renal and pelvic pathology, kidney transplantation and nephrectomy.

Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience.

RTx of adult-size kidneys presents a size mismatch in small pediatric recipients, and there are potential surgical complications. This study reveals the outcomes of intra- and extraperitoneal RTx in low-weight (less than 15kg) pediatric recipients. We studied 51 pediatric patients weighing less than 15kg who received a living-related donor renal transplant between 2009 and 2017. The intraperitoneal (group A, n=24) and extraperitoneal (group B, n=27) approaches were compared. In group A, the mean age, Ht, and weight were 3.8±1.6years, 83.7±6.5cm, 10.5±1.8kg; in group B, 5.0±1.9years, 95.3±7.3cm, and 13.0±1.4kg. Single renal artery grafts (21 in group A and 16 in group B) and double renal artery grafts (three in group A and 11 in group B) were performed. Of the patients with double renal artery transplants, one in group A and six in group B underwent ex vivo arterial reconstruction. The eGFR (mL/min/1.73m2 ) at 1-week post-transplant in group A was significantly higher than that in group B; the eGFRs at 4weeks post-transplant did not differ. One graft was lost in group B because of vascular thrombosis. Post-transplant complications included ileus and transplant ureteral stenosis. There was no significant difference in 5-year graft survival rate (group A 100%, group B 91.7%). Both transplant approaches are feasible to adapt to a size mismatch between the adult-size donor kidney and low-weight pediatric recipients.

Intrarenal Segmentation of the Renal Arteries in the Red Fox (Vulpes Vulpes Leinnoleus 1758) from Anatolia

This study was carried out to determine the biometric parameters and
 intrarenal segmentation of the renal arteries of kidney in the Red fox (Vulpes Vulpes Leinnoleus 1758).
 Corrosion cast method was applied to fourteen kidneys. It was found that the
 means for diameter of the aorta abdominalis, arteria renalis dextra and arteria
 renalis sinistra were 6.09 mm, 2.45 mm and 1.94 mm, respectively. Arteria
 renalis dextra was longer than the left artery. The renal arteries were divided
 into the dorsal and ventral branches. Both dorsal and ventral branches gave off
 the arteria interlobaris, arteria arcuata and arteria interlobularis,
 respectively. The right dorsal branch gave off 6 to 7 segmental arteries, the
 right ventral branch 5 to 7 segmental arteries, the left dorsal branch 6 to 8
 segmental arteries and the left ventral branch 4 to 7 segmental arteries.
 Double renal arteries were determined in 3 of 10 (30%) kidneys but only on the
 left side. As a result, arterial vascularization of red fox kidneys was
 examined and similarities and differences with other animal species were
 determined.

Outcomes of Laparoscopic Donor Nephrectomy in Presence of Double Renal Arteries – An Early Experience in a Developing Country

Introduction Since its description in 1995, Laparoscopic donor nephrectomy has gained widespread acceptance. The presence of two renal arteries in donor can pose a challenge to the surgeon. The multiplicity of donor artery may have an adverse effect not only on safety of donor but also on graft outcomes. However with increased experience and continuous evolution in instruments and surgical techniques, multiple renal arteries in laparoscopic donor nephrectomy are being performed successfully. Team work including donor surgeons, recipient surgeons and theater staff for accomplishment of a successful donor and recipient surgery is essential. Objective To evaluate the outcomes of laparoscopic donor nephrectomy with double renal arteries. Methods Data was retrieved retrospectively from May 2014 to Feb 2017. Patients with double renal artery who underwent laparoscopic donor nephrectomy were evaluated for laterality of side, operation time, ischemia time and hospitals stay. Results A total of 30 patients were included in the study. The male to female ratio was 3.3:1. Two kidneys were of right side. Maximum warm ischemia time recorded was 5 min 5 sec while mean was 193 ± 61 sec. There was no conversion in double renal artery. There was no primary graft failure. Conclusion Outcomes of laparoscopic donor nephrectomy with double renal artery is comparable to laparoscopic donor nephrectomy with single renal artery. There should be no hesitation in performing laparoscopy donor nephrectomy with double renal arteries in experienced surgical hands and can be done in resource poor country.

Presentation of double renal artery with double renal vein: A case report

Presentation of double renal artery with double renal vein: A case report

Testicular artery arising from an aberrant right renal artery

Testicular arteries usually arise from the abdominal Aorta; however they may rarely arise from other arteries of posterior abdominal wall. Variations of the testicular arteries and renal vessels are common. Awareness of these variations is very important to surgeons to increase their surgical precision and therefore avoiding iatrogenic injuries as well as useful in diagnostic procedures. This case report we discovered the rare variation of the origin of the right testicular artery arising from the right aberrant renal artery with double renal artery irrigating both left and right kidneys. These variations in the testicular arteries and renal arteries have implication to surgical procedures such as orchidopexy repair for undescended testis, renal transplantation and nephrectomy. Thus with the introduction of novel surgical and invasive diagnostic procedures understanding of these rare variations becomes significantly important. Currently these procedures are of increasing in our settings as such the information on variations is of prime importance.Keywords: Testicular artery; renal artery, variation, abdominal aorta