Polar Artery Research Articles

Variations in the branching pattern of renal artery

Background: In terms of living kidney transplantation programs worldwide, India is only second to the United States of America. Every year, over 7500 renal transplants are done in India, with 90% of the transplants coming from living donors and the rest from deceased donors. Aims and Objectives: The aim of the study is to examine and describe differences in human renal arteries, compare past studies with the present study, and report the occurrence of major categories of variation. Materials and Methods: This observational study was carried out on 25 well-embalmed adult cadavers in the Department of Anatomy, Rajah Muthiah Medical College, Annamalai Nagar, Chidambaram from December 2016 to October 2018. In all the 25 specimens, the renal artery took its origin from the lateral side of the abdominal aorta. Results: We observed that there is a 92% correlation between L1 and L2, 8% between L3 and L1, and zero between L1 and L2. Accessory renal artery (ARA) was discovered in 18 specimens (36%), with 10 on the right side and eight on the left. Superior polar arteries – 4 (8%), inferior polar arteries – 1 (2%), and hilar arteries – 5% on the right side (10%). Superior polar arteries – 6%, inferior polar arteries – 0%, and hilar arteries – 5% on the left side (10%). Conclusion: Living donor grafts have become a primary source for preserving the donor pool as the need for kidney transplantation rises, and a successful allograft with numerous arteries has become a must. All major vascular channels have not entirely regressed if there are polar or numerous renal arteries to a regularly positioned kidney.

Comprehensive evaluation of three-dimensional anatomy of perigastric vessels using enhanced multidetector-row computed tomography

BackgroundTo perform laparoscopic gastrectomy safely, we aimed to comprehensively re-evaluate perigastric vessel anatomies using a three-dimensional angiography reconstructed from enhanced multidetector-row computed tomography data.MethodsPerigastric vessel anatomy was preoperatively analyzed using a multidetector-row computed tomography-based three-dimensional angiography reconstructed in 127 patients undergoing gastric surgery.ResultsOf the 67 left gastric veins that ran along the dorsal side of the arteries, 59 (88.1%) ran along the dorsal side of the common hepatic artery and flowed into the portal vein. In 18 cases, a common trunk of one to three left gastric arteries and the replaced left hepatic artery was observed. The left inferior phrenic artery ramified from the left gastric artery in 5.5% of the cases. The right gastric artery was classified into distal (73.2%), caudal (18.1%), and proximal (8.7%) types. The infra-pyloric artery was also classified into distal (64.6%), caudal (26.0%), and proximal (9.4%) types. The posterior gastric artery branched as a common trunk with the superior polar artery in the proximal (37.9%) and distal (18.4%) regions of the splenic artery. The left gastroepiploic artery ramified from the splenic (18.1%) and inferior terminal arteries (81.9%). No, one, and two gastric branches of the left gastroepiploic artery, which ramified between the roots of the left gastroepiploic artery and its omental branch, were found in 36.5%, 49.2%, and 14.3% of the cases, respectively.ConclusionsPreoperative 3D angiography is useful for the precise evaluation of perigastric vessel anatomies, and may help us to perform laparoscopic gastrectomy and robotic surgery safely.

Successful Endovascular Repair of Infectious External Iliac Artery Anastomotic Pseudoaneurysm With Graft Preservation Post-Kidney Transplantation: Case Report and Review of Literature

Allograft artery-infected pseudoaneurysm (PA) represents a rare but life-threatening complication of kidney transplantation (KT). A review of the literature, showed that nearly all these cases ended resulted in graft loss. We presented a case of post-KT-infected external iliac artery anastomotic PA successfully managed by endovascular stenting with graft preservation. Additionally, we reviewed the pertinent literature. In this article, we described a hypertensive, 47-year-old man who presented 1 month post-cadaveric KT with acute kidney injury and gram-negative bacteremia secondary to a large infectious anastomotic PA of the external iliac artery. Because of favorable anatomy, successful arterial angio-stent fixation of the main renal artery PA, sparing the lower polar artery, was performed after 1 week of antibiotic and fungal coverage. Patient was discharged after 2 weeks with functioning graft. Graft function was stable after 3 months.

Variations in renal arteries and pelvicalyceal system: A case report

To describe a complex case of anomalous kidneys involving right early division of renal artery, left accessory renal artery, bilateral upper polar arteries and bilateral extrarenal calyces. This is a very rare case documented having these four anomalies together. The variations were observed during routine anatomical dissection in a male cadaver at department of anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, IndiaDuring dissection, multiple anatomical variations involving the structures at the hilum of right kidney were found. Right kidney showed early division of renal artery (RRA) 1.4 cm close to aorta. Left kidney showed accessory renal artery (LARA) 5 mm above origin of main renal artery (LRA), running obliquely entering the hilum. Two polar arteries were seen entering upper pole on right kidney as well as left kidney (RUPA1, RUPA2, LUPA1, LUPA2). Extrarenal calyces were observed to be present in both the kidneys, two on the right and three on the left. The variations observed are of importance as multiple anomalies are present in a single cadaver. They are of significance during surgical procedures like renal transplantation, aortic surgeries and in radiological interpretation.

Clinical correlation of renal vasculature variation

Background: The coupled renal arteries typically supply the kidneys, which are retroperitoneal organs. However, there are frequent changes in the way that the renal arteries and their perihilar branches are presented. Aim: The aim of the current research is to evaluate the occurrence of various renal arteries and give a medical association between them. Materials and Methods: The research material consisted of 30 formalin-fixed cadavers. While performing a regular abdominal dissection, the kidneys and their arteries were examined, and the morphological differences in the renal arteries were observed. Result: In 54.8% of the patients, numerous renal arteries were seen to arise from the abdominal aorta, including double hilar arteries (22.7%), triple hilar arteries (11.9%), superior polar and inferior polar arteries (13.2%), and numerous hilar and polar arteries (7.2%). Conclusion: For angiographic tests, kidney transplantation, and urological or radiological operations, understanding the renal vasculature, including its regular as well as variational structure, is essential. This information also makes embolization and angioplasties possible.clinical

Consequences of the coverage of polar renal arteries due to the treatment of the juxtarenal aneurysms with fenestrated stentgrafts

To evaluate the short and mid-term consequences on the renal function and the mortality of the coverage of polar renal arteries during the endovascular treatment of juxtarenal renal aneurysms (JRA) with fenestrated stentgrafts.

Variations of Renal Vasculature in Multi Detector Computed Tomography Evaluation of Abdomen

Introduction: Normal vascular supply to each kidney is by a single artery and vein on each side. This normal pattern is not found in all cases. Arterial variations can be accessory renal arteries which can be hilar, upper polar or lower polar and early branching. Venous variations can be late confluence, multiple renal veins and on left there can be retroaortic or circumaortic course of the left renal vein.
 Aims: To evaluate renal vasculature variations in patients who undergo contrast enhanced MultiDetector Computed Tomography of the abdomen.
 Methods: This was a hospital based cross sectional study done in 290 consecutive patients who underwent contrast enhanced Multi Detector Computed Tomography abdomen in Nepalgunj Medical College. Normal as well as variations in renal vasculature was evaluated.
 Results: Total of 158 (54.48%) cases had normal arterial supply. Out of 132 cases with renal arterial variation, 96 cases (72.7%) were unilateral and early branching was the most common unilateral renal arterial variation (36.4%) followed by upper polar (20.8%), lower polar (20.8%) and hilar (16.6%) arteries. Concurrent upper and lower polar arteries and combined early branching and lower polar arterial system were the most common multiple unilateral renal arterial variation seen in 2.08% cases respectively. 36 (27.27%) cases had bilateral renal arterial variations. Most cases had early branching in bilateral renal arteries seen in 9.09% cases. Venous variations were seen in 11.03%.Late confluence was the most common variation seen in 62.5% cases with variations. Rest were multiple renal veins. Left sided retroaortic and circumaortic course and bilateral renal vein variations were not found in our study.
 Conclusion: Renal vasculature variations were frequently observed in routine contrast enhanced Multi Detector Computed Tomography evaluation of abdomen. Renal arterial variation was more common than venous variations. Unilateral variations were more common than bilateral.

The Splenic Artery and Segmental Branches Morphometric Study in Humanoid Cadaver Spleens by Method of Dissection

In the human body; the major lymphatic organ is the spleen supplied by the splenic artery, the main division of the celiac trunk. It crosses the lienorenal ligament and approaches the spleen hilum where it splits into 2-3 main branches, each of which divides mainly into 2-4 secondary branches. Also, inferior and superior polar arteries arise from the primary branches or splenic trunk and pass into the spleen pole without entrance in the hilum. The purpose of this analysis was to understand the segmental branches morphometry of the polar and splenic arteries. Methods: The analysis was performed on 86 spleens collected from adult human cadavers of not known gender, stored in formalin 10% solution obtained from the Anatomy and Forensic Medicine Department, by dissection. Place and Duration: In the department of anatomy, Multan Medical and Dental College and Bacha Khan Medical Complex Swabi for six months duration, from August 2021 to January 2022. Results: In 59 (68.6%) spleen samples; there were 2 primary branches, 23 (26.7%) samples have three primary branches, and 4 (4.7%) specimens have four primary branches. 20 (23.3%) samples have superior polar arteries, 34 (39.5%) have inferior polar arteries, and both inferior and superior polar arteries in 7 (8.1%) samples. The superior polar artery length varies from 0.8-5.51 cm, with 2.80 cm of average length and 2.4 cm median length. The inferior polar artery length ranged from 0.9-5.90 cm, with 3.17 cm of average length and 3.30 cm median length. The superior PB diameter ranged from 0.8-4.12 mm, with 2.20 mm average length and 2.4 mm median length. The mean diameter of middle PB ranged from 0.8 mm to 3.6 mm, with an average of 2.10 mm and 2.4 mm median length. The PB inferior diameter ranged from 0.6 mm to 4.4 mm, with an average of 2.13 mm and 2.10 mm median length. The superior polar artery diameter ranged from 0.5-3.1 mm, with 1.40 mm average length and 1.4 mm of median. The inferior polar artery diameter varies from 0.5-2.9 mm, with 1.3 mm of an average diameter with 1.4 mm median. Conclusions: As various splenic sparing surgeries depend on better information of the vascular anatomy of the spleen, this analysis enhances the current information about the segmental branches’ morphometry of the splenic artery. Keywords: Splenic artery, Polar artery and Segmental branches

Results of anastomosis of accessory lower polar graft artery to internal iliac artery in renal transplantation

Background: Our objective is to perform a renal graft transplant using multiple arteries where the lower polar artery will indeed be anastomosed to the internal iliac artery end to side following declamping the main arterial supply in terms of ischemia time, diuresis, graft perfusion, and postoperative clinical parameters and investigations. Methods: Fifty live donors underwent vascular anastomosis of the graft auxiliary lower polar artery to recipient internal iliac artery end to side anastomosis with various renal arteries bilaterally, including lower polar artery in chosen kidney. The recipients' intraoperative warm and total ischemia periods, as well as their postoperative incidence of acute tubular necrosis, were assessed (ATN). Diuresis, urinary output, and creatinine levels at 1, 3, and 5 days after surgery, as well as at 2 months afterwards. MRI and Doppler ultrasonography, if necessary. Results: In contrast to warm, the mean total ischemia time was 20.86 minutes. Low incidence of ATN (8%) was controlled and postoperative recovery went without a hitch. Regarding postoperative urine output and serum creatinine level monitoring, clinical and laboratory indicators were satisfactory. Depending on the assessment method, colour Doppler ultrasonography reveals well perfused transplanted grafts with a satisfactory peak systolic velocity ratio in the auxiliary graft artery.

The Splenic Artery and Segmental Branches Morphometric Study in Humanoid Cadaver Spleens by Method of Dissection

Human spleen has various functions including immune system regulation and haematopoisis. The spleen is an extremely vascularized and fragile organ. It is the second major lymphatic organ, containing 25% of lymphoid tissue in the body, and has haematologic and immunologic roles. Objective: To understand the segmental branches morphometry of the polar and splenic arteries. Methods: The analysis was performed on 86 spleens collected from adult human cadavers of not known gender, stored in 10% formalin solution. In the Department of Anatomy, Mohi-ud-Din Islamic Medical College (MIMC), Mirpur, Azad Jammu & Kashmir and Women Medical and Dental College Hospitals, Abbottabad for six- months duration from July-December 2021 Results: In 59 (68.6%) spleen samples; there were 2 primary branches, 23 (26.7%) samples had three primary branches, and 4 (4.7%) specimens had four primary branches. 20 (23.3%) samples had superior polar arteries, 34 (39.5%) had inferior polar arteries, and both inferior and superior polar arteries in 7 (8.1%) samples. The inferior polar artery length ranged from 0.9-5.90 cm, with 3.17 cm of average length and 3.30 cm median length. The superior PB diameter ranged from 0.8-4.12 mm, with 2.20 mm average length and 2.4 mm median length. The mean diameter of middle PB ranged from 0.8 mm to 3.6 mm, with an average of 2.10 mm and 2.4 mm median length. The superior polar artery diameter ranged from 0.5-3.1 mm, with 1.40 mm average length and 1.4 mm of median. The inferior polar artery diameter varies from 0.5-2.9 mm, with 1.3 mm of an average diameter with 1.4 mm median. Conclusions: As various splenic sparing surgeries depend on a better information of the vascular anatomy of the spleen, this analysis enhances the current information about the segmental branches’ morphometry of the splenic artery.

Evaluation of renal vascular variations with computed tomography

BackgroundIt is important to know the renal vascular variations before renal surgeries and invasive procedures. The aim of this study is to evaluate the prevalence and types of variation of renal arteries and veins.MethodsThe abdominal CT images of 460 patients, taken between 2019 and 2021, were retrospectively analyzed in axial and coronal planes. The presence and number of accessory renal arteries and early branching in the main renal artery were evaluated. Then, bilateral renal vein variations were investigated. Finally, the compression of the left renal vein by different anatomical structures was evaluated.ResultsOf the 450 patients included in the study, the mean age was 53 years. No variations were detected in 378 renal arteries on the right side (84%) and 392 renal arteries on the left side (87.1%). The most common variation in renal arteries was an accessory inferior hilar artery in 7.5% and 6% rates on the right and left, respectively. An accessory inferior renal polar artery was observed at an overall rate of 1.3%. An accessory superior renal hilar artery was found at 3.3% and 2% rates on the left and the right, respectively. An accessory superior renal polar artery was found at an overall rate of 3.5%. Multiple variations in the renal arteries were observed at a rate of 6.4%. Early branching was observed at a rate of 4.9% on the right and 2.2% on the left. The presence of two and three right renal veins was observed at rates of 13.1% and 0.6%, respectively. Retroaortic and circumaortic left renal veins were found at 3.5% and 4.4% rates, respectively. The compression on the anterior and posterior left renal veins was observed at 4.6% and 0.9% rates, respectively.ConclusionConsidering that variations in renal arteries and veins are too many and of different types to underestimate, a CT examination for the renal vascular anatomy before and at the planning phase of renal surgery or interventional procedures will be of great benefit to avoid potential complications.

The Arterial Anastomosis Between Deep Inferior Epigastric Artery and Small Polar Renal Artery in Kidney Transplantation: A Case Report

The presence of multiple renal arteries is the most common form of vascular anomalies found in donor kidneys. In rare cases, small renal polar arteries may be found. They can be anastomosed with deep inferior epigastric arteries, resulting in vascular augmentation of transplanted kidneys and contributing to better graft function. Renal perfusion may be increased via 2 types of vascular reconstruction known as "turbocharging" and "supercharging". Turbocharging uses vascular sources within the same organ area, whereas supercharging uses distant vascular sources. Using additional vessels can either complicate the surgery or, contradictorily, ease the way of procedure. This case study presents a kidney transplant during which arterial anastomosis between deep inferior epigastric artery and small polar renal artery was performed.

Bilateral extra‐renal pelvises and calyxes with additional renal blood vessel variations identified in a single prosected medical school donor body

While there are relatively commonly observed, reported anatomical variations associated with the posterior abdominal wall, especially with the kidneys, we report here over a dozen variations in one prosected medical school donor body (Caucasian, male, age 87, cause of death: sepsis). These variations could contribute significantly to negative outcomes, especially in surgical procedures. During a routine dissection, we found bilateral extra‐renal pelvises. In the right kidney, there were two extra‐renal major calyxes, and five extra‐renal minor calyxes (two extra‐renal minor calyxes from the superior major calyxes, and three extra‐renal minor calyxes from inferior major calyxes). In the left kidney, there were four extra‐renal major calyxes and two extra‐renal minor calyxes off the most inferior major calyx. In addition, we found four venous variations and four arterial anomalies including one in a major artery. Namely, there were bilateral accessory renal veins found at the hilum that drained into the posterior aspect of the inferior vena cava. There was an additional accessory left renal vein that drained into the left renal vein, at the junction of the left testicular and left suprarenal veins. There was also a left lumbar vein that drained into one of the accessory left renal veins. Regarding the arterial supply to the kidneys, there were two polar right renal arteries directly off the abdominal aorta in addition to two long hilar right renal arteries, and three left hilar renal arteries that branched individually from the abdominal aorta. Finally, there was a long left common iliac artery compared to the right common iliac artery. Anatomical variations within patients can be of no significance or can turn a routine surgical procedure into a hazardous process if unrecognized at the time of intervention. Further documentation of such anatomical variations in prosected donor bodies can further inform surgeons for the need for imaging prior to various surgical procedures.

Systematic Review and Meta‐analysis of the Anatomical Variants in Renal Vascularization and their Clinical Implication using Anatomical Quality Assurance (AQUA) checklist

IntroductionAnatomically, the vascularization and venous drainage of the kidney is provided by the renal artery and vein. Generally, the kidney consists of a renal artery originating in the abdominal aorta, which later divides into an anterior and posterior branch, however it is not uncommon to find more than one emerging from the abdominal part of the aorta, in addition to some iliac artery or rarely originating from the lower thoracic aorta or mesenteric arteries. On the other hand, the renal veins drain on the inferior vena cava, but the left renal vein a longer course, crossing the midline anterior to the abdominal aorta and posterior to the superior mesenteric artery.Materials and methodsWe considered specific scientific articles and books of human anatomy, written in Spanish or English, published between 2000 and 2021. The search process was carried out in the following databases: MEDLINE, SCIELO, WOS, CINHAL, SCOPUS and GOOGLE SCHOLAR, using as search terms “renal artery ”, “anatomical variation”, “renal veins”, “” and “renal vascularization” for which the following Boolean connectors “AND”, “OR” and “NOT” were used, also to see the bias was used The Anatomical Quality Assurance (AQUA) checklist.ResultsRegarding the incidence of the variants in renal vascularization, these are reported as follows; variants only of the renal artery, variants only of the renal vein and finally variants of both the artery and the renal vein. For the variants of the origin of the renal artery, four studies with an N greater than 1 in their sample, reported variation in the origin of the renal artery where this artery has two branches that originate from the aorta artery, one that is polar superior or lower and the other is directed towards the renal hilum. In these studies, the incidence varied between 16.66% and 31% with a mean of 25.54% and a cumulative n of 1594 patients. For the variant of the origin of Renal artery in studies with N equal to 1, three studies were presented, of which two presented an accessory inferior polar artery, while one study presented origin of the renal artery at the level of the thoracic aorta. Regarding the incidence of variation in the trajectory of the renal artery, eight studies were found, which reported variations in the trajectory of the renal artery, which were mainly multiple renal arteries that bifurcated laterally to their origin in the abdominal aorta artery. While one study showed multiple renal artery surrounding the abdominal aorta artery, the incidence of these variations fluctuated between 6.7% and 100% with a mean of 62.45% with a total accumulated N of 879 in the sample of the included studies.ConclusionsThe amount of variations in renal vascularization is very wide, so the knowledge of professionals who treat pathological conditions of the abdominal region becomes crucial, since ignoring these variations could lead to complications in the surgical approach or in the diagnosis. We also believe that future studies that associate these variations with some pathologies would also be important.

Description of an atypical vascular arch in the renal parenchyma

Introduction: Variability in renal vascularization occurs with a frequency of around 30%. During the routine dissection of one cadaver without renal pathology, we revealed the presence of one. Material and Methods: Dissection of a cadaver carried out in the practicing room of School of Medicine. Results: During the routine dissection of one cadaver without renal pathology, we revealed the presence of an early bifurcation of the renal artery on the left side, and the presence of two polar arteries – superior and inferior -, the latter presenting an anterior and posterior vascular arch to the renal pelvis in the parenchyma, which anastomoses the pre- and retro-pyelic branches of the renal artery with the pre- and retro-pyelic branches of the inferior accessory polar artery. In addition, the presence of an accessory polar artery was observed in the right kidney. Discussion and Conclusion: For vascular surgeons, knowledge of this anatomical variation is of real clinical relevance in cases such as fenestrated endografting in order to preserve the function of the entire kidney.

Anatomical Variations of Renal Artery in Patients Undergoing Computerized Tomographic Scan in Sudan

Anatomical Variations of Renal Vascular in Patients Undergoing Computerized Tomographic scan in Sudan, the total number of patients studied is 400, 202 (50.5%) males and 198 (49.5%) females, and their ages ranged between (3 - 94) years. The study showed mean of total samples of the width and length of right and left kidneys respectively measurements were 5.354 ± 0.948 and 5.571 ± 0.966 for width and 10.028 ± 1.3684 and 10.060 ± 1.5203 for length, the width and length for right renal artery 5.746 ± 1.2814 and 5.881 ± 1.1444 respectively and for left renal artery 5.894 ± 1.3175 and 4.961 ± 1.3175 respectively. Accessory renal artery is a common but a significant anatomical variant of the renal vascular system, due to its clinical importance. In our sample, the accessory renal artery presence was detected in 6% and displayed a greater variation on the right than the left side. Because this abnormality plays an important role in kidney transplantations, in radiological, vascular and urological interventions, a detailed presentation of accessory renal artery incidence was conducted, gathering from the literature a large number of relevant studies in order to create a classification according to population, gender, side and specimen. And the study concluded that the renal arteries present a broad spectrum of variability in their morphological expression regarding their length, diameter and entrance to the kidney parenchyma. The inferior polar renal artery was found same as the superior polar renal artery, additional arteries’ morphological expression was higher in men than women. This is statistically not significant and variation in the right side was found greater frequency than the left side.

Pelviureteric Junction Obstruction Due to Vascular Anomalies in Children - Simple Surgical Options.

ABSTRACTAims:Pelviureteric junction obstruction (PUJO) due to aberrant lower polar artery is conventionally managed with pyeloplasty. We present our experience of managing PUJO due to “vascular” anomalies-aberrant lower polar artery and vascular adhesions with simpler surgical options.Subjects and Methods:This is a protocol based, retrospective study of PUJO. Preoperative investigations included ultrasonography (USG) and diuretic renogram. An intraoperative methylene blue test (MBT) assessed transit across the Pelviureteric junction (PUJ) after release of vascular compression. Surgical management included adhesiolysis for vascular adhesions and pyelopyelostomy anterior to the aberrant polar artery. Postoperative studies were repeated after 3 and 6 months.Results:Fourteen of 144 PUJO (9.7%) were “vascular” obstructions. Those with vascular adhesions (six) were largely infants with antenatal hydronephrosis. Children with aberrant lower polar artery (eight) were older, had fleeting symptoms, minimally increased pelvic diameter and subtle impairment on diuretic renogram. Majority were term males with urinary tract infection. The MBT showed normal transit across the PUJ in all. Postoperatively, there was progressive improvement on USG and diuretic renogram after 3 and 6 months. None had any complication or redosurgeries. At a mean follow-up of 41.2 months, all are asymptomatic.Conclusions:PUJO due to extrinsic vascular anomalies is rare. Intraoperative evaluation with the MBT ruled out associated intrinsic pathology. We describe two simple surgical alternatives preserving the normal PUJ - adhesiolysis for vascular adhesions and pyelopyelostomy for aberrant lower polar artery. The preliminary outcomes are comparable to conventional pyeloplasty.

Current practice with grafts with multiple renal arteries in kidney transplantation: role of the methylene blue in the lower pole.

Kidneys with multiple renal arteries (MRAs) from different patches, may provide to the surgeon additional technical difficulties that make kidney transplants very challenging. MRAs have been largely debated over the years whether to be anastomosed or not due to the disappointing outcomes when it comes to inappropriate ligation or anastomosis. Some authors empirically reassure that smaller branches can be safely ligated and dissected without intraoperative and postoperative complications or compromising the functional recovery of the graft. Literature is poor about the possible differences in the management of superior and inferior polar arteries. Inferior polar arteries represent a topic of great interest as they may also supply the proximal ureter. The aim of this article is to merge the current knowledge about the management of inferior polar arteries and to highlight if there is any role of the methylene blue dye (MB) in the study of the ureteral vascularization in kidney transplantation. MB can be considered a safe and simple tool of vascular perfusion assessment in kidney transplantation. By injecting the dye-solution into the inferior MRA hidden ureteral branches can be unmasked and guide the surgeon to preserve important vessels. In view of their fundamental role in the vascularization of the ureter, the lower polar arteries of the graft, should be invariably studied by MB. It provides an objective, simple and fast tool for the evaluation of the ureteral vascularization when injected through the inferior MRA of the graft. (www.actabiomedica.it)

A rare case of graft lower polar artery aneurysm: Delayed presentation after 10 years - A case report

Graft artery aneurysms though rare, may have devastating consequences. We present a case of an aneurysm involving the lower polar artery anastomosed to external iliac artery using a gonadal vein graft. The patient presented with sudden onset graft fossa swelling, pain, and decreased urine output. Color Doppler and computed tomography angiography helped in diagnosis and management. Since the majority of the graft was well-perfused by the upper polar artery, the patient underwent excision of the lower polar artery aneurysm. The prompt diagnosis and management salvaged the graft. This aneurysm presented after 10 years of the underlying importance of long-term surveillance.

Incidentally Detected Anomalous Renal Arteries during Angiogram- A Case Series

Modern medical society is witnessing increased surgeries for various renal pathologies like renal transplantation and vascular abnormalities. Anomalous origin of renal vasculature might interfere with surgical procedures and outcomes. Hence, accurate roadmap of renal vasculature is necessary for surgeons. Non invasive or minimally invasive imaging techniques help in accurate demonstration of renal vasculature and aid in minimising trauma during surgeries. Preoperative assessment of live renal donor by conventional angiography is a protocol in the institute. A retrospective analysis of anomalous renal arteries was done in a total of 381 cases that were being done in Digital Subtraction Angiography (DSA) suite in Radio Diagnosis Department from 2015 to 2021. In this case series of four patients, different types of anomalous renal arteries have been presented that were incidentally detected during angiograms. Single accessory renal artery was the most common finding in our study followed by multiple accessory renal arteries. Supra coeliac origin of right renal artery was noted in one case which was a rare finding with very few similar case reports in literature. In addition, there was an extremely rare case presentation showing bilateral lower polar accessory renal arteries. They had one common origin, arising from abdominal aorta at the level of aortic bifurcation. No similar case reports have been found in literature and probably the present one is first one of this kind. Knowledge of various anomalies is of utmost importance for the awareness of clinicians and for surgical success.