Presence Of Accessory Renal Arteries Research Articles

THE EFFECT OF THE PRESENCE OF ACCESSORY RENAL ARTERIES ON BIOCHEMICAL PARAMETERS OF RENAL FUNCTION AND BLOOD PRESSURE REGULATION

Objective: The effect of having accessory renal arteries on hemodynamics and renal function has been studied in different populations, yielding variable results – from a significant correlation between the presence of accessory renal arteries and increased arterial blood pressure and/or serum creatinine and renin to no correlation whatsoever. The aim of this study was to evaluate the effects of the presence of accessory renal arteries on biochemical parameters related to renal function and hemodynamics in a Croatian population. Design and method: This was a retrospective single-center study. Data was collected from the hospital informatics system on patients with accessory renal arteries managed in the arterial hypertension clinic of a tertiary care center. Patient data obtained between 2012 and 2023 was included. In order to be included into the study, patients needed to have available data on laboratory parameters, hemodynamics and an image of a multi-slice computed tomography intravenous contrast-enhanced scan of the aorta and renal arteries. Patients without all of the aforementioned data were excluded from the study. Data was analyzed using the JASP open-source statistical software. Statistical significance was set at a threshold of p < 0.05. Results: 155 patients in total were included in the study – 80 without accessory renal arteries and 75 with one or more accessory renal arteries. The distribution of age and gender was equivalent between the two groups. The group with accessory renal arteries had significantly higher mean arterial pressures (100 mmHg vs 95.7 mmHg, p = 0.016), lower estimated glomerular filtration rates calculated by CKD-EPI 2021 formulas (80 mL/min/1.73m2 vs 96 mL/min/1.73m2, p < 0.001) and had a significantly higher number of antihypertensive medications in their therapy (3 vs 1.5 different types of medications, p < 0.001). There were no significant differences between other measured parameters (serum electrolytes, renin, aldosterone, aldosterone/renin ratio). Conclusions: The results of this study indicate that the presence of accessory renal arteries might have an effect on the success of antihypertensive therapy and that these patients may represent a distinct phenotypic group that requires a personalized approach.

IMPACT OF ACCESSORY RENAL ARTERIES ON HYPERTENSION IN YOUNG PATIENTS

Objective: To determine whether there is a correlation between hypertension, accessory renal arteries, and levels of renin and aldosterone. Design and method: From March 2023 to December 2023, 11 young patients (9 males and 2 females) between 22-41 years were hospitalized with suspected secondary arterial hypertension (AH). Prior to hospitalization, all underwent standard pre-analytical medication preparation with cessation of hormone affecting medications and transferred to alternative treatment. For all patients, a computer tomography was conducted following a renal angiography protocol for the presence of adrenal glands formations and the presence of accessory renal arteries. In parallel with the imaging study, laboratory analyses for renin/aldosterone, metanephrine, and normetanephrine were done. ECG, echocardiography and 24-hour monitoring of arterial blood pressure were performed. Results: In 10 (91%) of the examined patients, accessory renal arteries were identified - 2 (20%) on the right with two accessory renal arteries; 4 (40%) on the left, and the remaining 4 (40%) had bilateral accessory renal arteries. One patient exhibited an accessory artery in conjunction with Nutcracker Syndrome, and another patient with a combination of a hormonally inactive adenoma of the right adrenal gland. The average blood pressure during 24-hour monitoring was 165/96±12/8 mmHg. Echocardiography revealed initial left ventricular hypertrophy in 50% of the examined patients, with a trend towards reduced relaxation. Overall, 8 patients had abnormal renin/aldosterone abnormalities - 7 (64%) in the group with accessory renal arteries (ARA), and 1 (9%) in the group without ARA where primary hyperaldosteronism was diagnosed. In the ARA, 6 had elevated levels of both renin and aldosterone. In 1 case in ARA group, only renin was elevated. Metanephrine and normetanephrine levels were within normal limits in all cases. Conclusions: We find relatively high rate of the presence of ARA, which may be regarded as an etiological entity. Elevated levels of renin and aldosterone were detected in a significant subset of the patients. Hypertensive patients with ARA may develop early severe damage of target organs.

Multiphasic MDCT of Living Renal Donors, Prior to Surgery

Background: Live kidney donor evaluation mandates anatomical and functional assessment of the donor kidney. Multiphasic Multidetector computed tomography (MDCT) with advanced 3‐D techniques provides a detailed description of the vascular, parenchymal, and collecting system. Objectives: To evaluate the clinical application of Multiphasic MDCT in the pre-operative anatomic assessment of prospective donor kidneys. Methods: Multiphasic MDCT was performed in thirty-eight patients as part of a pre-operative assessment. Each study comprised three phases of imaging, including the arterial, venous, and excretory phases. Results: The predominant radiological finding amongst the cases studied was that of the presence of accessory renal arteries in 35% of the patients. Multiphasic MDT was also able to detect renal parenchymal disease in one case. Post-renal anatomical evaluation also identified renal calculi in 12.5% of the total cases. Conclusions: There is considerable scope for multiphasic MDCT in the pre-operative evaluation of donor kidneys, especially as modern-day renal transplant surgery sees a shift towards laparoscopic techniques where intraoperative anatomic evaluation can be restricted. The multiphasic MDCT is useful in pre-renal, renal, and post-renal anatomic evaluation. Advances in Knowledge: Multiphasic MDCT can provide noninvasive, detailed, and fast images to aid the preoperative evaluation of donor kidneys.

EVALUATION OF ANATOMICAL VARIATIONS OF EXTRARENAL RENAL ARTERIAL VASCULATURE IN VOLUNTARY KIDNEY DONORS

Objective: The present study was aimed at evaluating the variations in extrarenal renal arterial vasculature in voluntary kidney donors who had undergone Multi-Detector Computed Tomography (MDCT) renal angiography for preoperative workup. Methods: A retrospective hospital based cross-sectional study was carried out in a tertiary care Army hospital in Delhi from Jan 2019 to June 2020. All voluntary kidney donors included in the study underwent Multi-Detector Computed Tomography Angiography (MDCTA) of renal arteries as a part of routine pre-operative imaging protocol and were referred by the treating physician/surgeon for MDCTA study. Retrospective analysis of the image datasets was undertaken by the principal investigator and individual patient consent was waived off by the institutional Ethics committee. Results: The mean age of study participants was 45.9±10.2 y. Accessory renal artery was relatively more common on left side (p-value 0.001). There was statistically no significant difference between gender and the presence of accessory renal artery. There was statistically no significant difference on the comparison of side and gender with distance of segmentary bifurcation of MRA. The orthogonal diameters at the origin of the MRA and accessory renal artery on both sides were also comparable. Origin of accessory renal arteries were caudal to MRA was more frequently seen. Early segmentary bifurcation of MRA was commoner on the right side. Conclusion: The study emphasizes the importance of meticulous preoperative assessment, highlighting the need for surgeons to be cognizant of the potential variations in extrarenal renal artery anatomy. Such awareness is crucial for planning successful kidney transplant surgeries.

Case Series on Double-Barrel Stenting for the Renal Arteries Associated With Fenestrated Repair (FEVAR) of Complex Anatomy Aortic Aneurysms.

The double-barrel stenting (DBS) is a technique in which 2 parallel stents are simultaneously deployed through the same reinforced fenestration, into 2 adjacent target vessels. Prior reports describe the application of this technique for the treatment of superior mesenteric artery dissection with aneurysmal degeneration, coronary artery bifurcations, aortic arch branches, and intracranial aneurysms. The DBS technique is particularly useful in the context of fenestrated repair (FEVAR) of complex anatomy aortic aneurysms when the origin of visceral arteries branch off the aorta very close to each other or present early branches. We herein describe a case series including 7 patients who underwent a FEVAR procedure for thoracoabdominal and juxtarenal aortic aneurysms in which the presence of accessory renal arteries (ARA) or early renal branches was the reason for the application of this technique. Technical success was 100% and all stents were patent in the last follow-up CT scan (follow-up range: 1.8-62.8 months). There was only 1 small endoleak from indetermined source potentially related to the DBS, but the aneurysm sac decreased in size during follow-up and no secondary intervention was needed. Therefore, the DBS technique is a viable option for the incorporation of ARA or early renal branches to a fenestrated repair of aortic aneurysms with complex anatomy.

Anatomic Variations of Renal Arteries as an Important Factor in the Effectiveness of Renal Denervation in Resistant Hypertension.

Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years, there has been an increased interest in invasive hypertension treatment methods. Long-term effects and factors affecting renal denervation effectiveness are still under investigation. Some investigators found that the renal arteries' morphology is crucial in renal denervation effectiveness. Accessory renal arteries occur in 20-30% of the population and even more frequently in patients with resistant hypertension. Diversity in renal vascularization and innervation may complicate the renal denervation procedure and increase the number of people who will not benefit from treatment. Based on previous studies, it has been shown that the presence of accessory renal arteries, and in particular, the lack of their complete denervation, reduces the procedure's effectiveness. The following review presents the anatomical assessment of the renal arteries, emphasizing the importance of imaging tests. Examples of imaging and denervation methods to optimize the procedure are presented. The development of new-generation catheters and the advancement in knowledge of renal arteries anatomy may improve the effectiveness of treatment and reduce the number of patients who do not respond to treatment.

Characterization of renal artery variation in patients with clear cell renal cell carcinoma and the predictive value of accessory renal artery in pathological grading of renal cell carcinoma: a retrospective and observational study

ObjectiveTo explore the characteristics of renal artery variation in patients with renal cell carcinoma and to evaluate the predicting value of accessory renal artery in the pathological grading of renal cell carcinoma.MethodsThe clinicopathological data of patients with clear cell renal cell carcinoma diagnosed in the Department of Urology of the First Hospital of Shanxi Medical University from September 2019 to March 2023 were retrospectively analyzed. All patients underwent visual three-dimensional model reconstruction from computed tomography images. All kidneys were divided into two groups: the affected kidney and the healthy kidney, and the incidence of renal artery variation in the two groups was analyzed. Then, according to the existence of accessory renal artery in the affected kidney, the patients were divided into two groups, and the relationship between accessory renal artery and clinicopathological features of patients with clear cell renal cell carcinoma was analyzed. Finally, univariate and multivariate logistic regression analyses were performed to determine the predictors of Fuhrman grading of clear cell renal cell carcinoma, and the predictive ability of the model was evaluated by the receiver operating characteristic curve.ResultsThe incidence of renal artery variation and accessory renal artery in the affected kidney was significantly higher than them in the healthy kidney. The patients with accessory renal artery in the affected kidney had larger tumor maximum diameter, higher Fuhrman grade and more exophytic growth. The presence of accessory renal artery on the affected kidney and the maximum diameter of tumor are independent predictors of high-grade renal cell carcinoma. The receiver operating characteristic curve suggests that the model has a good predictive ability.ConclusionThe existence of accessory renal artery on the affected kidney may be related to the occurrence and development of clear cell renal cell carcinoma, and can better predict Fuhrman grade of clear cell renal cell carcinoma. The finding provides a reference for the future diagnostic evaluation of RCC, and provides a new direction for the study of the pathogenesis of RCC.

Multidetector computed tomography angiography study of the renal arterial vasculature anatomy and its variations in a Bulgarian adult population.

Renal arterial anatomy has a great clinical importance during surgical and endovascular procedures. However, comprehensive data on renal arterial variations in the Bulgarian population has not yet been provided. The aim of this study was to conduct a detailed research about the normal anatomy and variations of the renal arteries in the Bulgarian population. Five hundred sixty-one patients underwent contrast-enhanced multidetector computed tomography scans for the period 2016-2021. The images were retrospectively reviewed. Number, branching pattern, origin level and course of the renal arteries were noted. Data were categorized on the basis of laterality, gender and symmetry. Only 46.3% of the patients exhibited normal renal arterial anatomy. Variations were observed in 301 patients (53.7%). The most common variant was the presence of accessory renal arteries (ARA), discovered in 41.2% of the subjects. There was no significant difference based on gender and laterality (p > 0.05). Hilar ARA (72.6%) were significantly more common than polar ARA (p < 0.001). The most common origin location of the main renal arteries and ARA was the aorta, followed by the common iliac arteries. Early division was observed in 21.7% of the patients, significantly more common on the right. Precaval course was found in 0.5% of the right main renal arteries and in 30% of ARA and the difference was significant (p < 0.001). These results show novel insight into the prevalence of renal arterial variations in the Bulgarian population. Anatomic renal vasculature variants are common therefore awareness is crucial for the success of surgical and interventional procedures.

Estimating Lengths of Renal Arteries and Infrarenal Aorta on Contrast CT Scans- A Retrospective Study

Introduction: Anatomy of renal arteries and length of infrarenal aorta play a vital role in various renal and aortic vascular interventions and surgical procedures including renal transplantation. Aim: To estimate mean lengths of renal arteries, the vertical distance between origins of both renal arteries, infrarenal aortic lengths, and presence of accessory renal arteries on contrast Computed Tomography (CT) scans. Materials and Methods: A retrospective hospital-based study was conducted at KVG Medical College and Hospital, Sullia, Karnataka, India in which contrast enhanced CT scans of the abdomen was performed between October and December 2021. The CT image datasets of 61 individuals were evaluated in the study, of which 45 were males and 16 were females. The arterial phase images were anonymised and loaded in the curved Multiplanar Reformatted (MPR) algorithm. The lengths of both Renal Arteries (RA), vertical distance between origins of both Renal Arteries (RAD), infrarenal Aortic Lengths (AL), and presence of accessory renal arteries were noted. For statistical analysis Statistical Package for the Social Sciences (SPSS) software version 22.0 was used and Pearson’s Chi-square test and independent t-test were used for calculation. Results: The mean age of the participants was 50.7±7.5 years. Mean right RA was 3.75±1.25 cm and left RA was 2.89±0.98 cm. Right RA was significantly longer than left RA (p=0.019). Mean RAD was 0.61 cm. In 35 cases of (57%) right RA originated at a higher level than the left RA. The mean AL was 9.68±1.18 cm. Accessory renal arteries were seen in nine of cases (14.8%). Conclusion: The mean measurements obtained can provide vital guidance during renal and aortic surgeries and vascular interventions.

Correlation between Renal Artery Anatomy and Hypertension: A Retrospective Analysis of 3000 Patients.

Objective To assess the correlation between renal artery anatomy and blood pressure in Undiagnosed Hypertension and Diagnosed Hypertension. Methods The renal artery CT scanning imaging data and laboratory data of 3000 inpatients and outpatients were collected retrospectively in 4 centers of China. Morphometric parameters were assessed using the quantitative vascular analysis (unit: mM). Results 687 cases (23.2%) had accessory renal arteries unilaterally, and 216 cases (7.3%) had bilateral accessory renal arteries, including left kidney 825 (27.9%) and right kidney 798 (27.0%). The presence of accessory renal arteries and renal artery branches was higher in the diagnosed hypertension group as compared with the undiagnosed hypertension group (MARB, pp < 0.001; ARA, p < 0.001; others, p < 0.001). Consequently, multivariate regression analysis showed that age (OR = 2.519 (95% CI: 0.990–6.411, p < 0.001)), dyslipidemia (OR = 1.187 (95% CI: 0.960–1.454, p = 0.007)), renal hilum Outside the main renal artery branch (MRAB) (OR = 2.069 (95% CI: 1.614–2.524, p = 0.002)), and accessory renal artery (ARA) (OR = 2.071 (95% CI: 1.614–2.634, p = 0.001)) were risk factors of hypertension. In addition, higher renin activity was associated with ARA patients (2.19 ± 2.91 vs. 1.75 ± 2.85, p < 0.001). Conclusions When comparing renal arteries side by side, the anatomical length of the renal arteries is significantly different. In addition, the prevalence of accessory renal arteries and renal artery branches is higher in the hypertension group. The auxiliary renal artery and the main renal artery branch outside the renal portal are independent factors of hypertension. Renal sympathetic nerve activity is affected by renin activity and is related to the accessory renal artery.

Accessory Renal Arteries; Clinical Features and Prognosis in Hypertensive Children

Objective: Accessory renal arteries may be related to the risk of renovascular hypertension. This study aims to evaluate the clinical course of accessory renal arteries in children with hypertension. We also aimed to compare renal function tests, blood pressure loads, frequency of end-organ damage, and prognosis of hypertensive patients who had detected single and accessory renal artery with Magnetic Resonance Angiography. Material and Methods: From 01 January 2015 to 31 December 2017 medical records of hypertensive patients were retrospectively reviewed and patients who had been evaluated with Magnetic Resonance Angiography for differential diagnosis of renovascular hypertension were selected. Hypertensive patients with single renal arteries and those who had accessory arteries were compared in the terms of findings Doppler Ultrasound, blood pressure load, and presence of end-organ damage, laboratory investigations, treatment modalities, and prognosis. Results: Of 49 hypertensive patients who underwent Magnetic Resonance Angiography, 26 (51%) showed accessory renal arteries. Despite the normal Doppler Ultrasound, 13 patients were found to have accessory renal artery with Magnetic Resonance Angiography. There was no significant difference between blood pressure load, and laboratory investigations between the patients with single renal arteries and those who had accessory renal arteries. The frequency of end-organ damage was also similar between both groups at the end of follow-up period as well as the number of medications. Conclusion: Magnetic Resonance Angiography is more successful than Doppler Ultrasound to detect accessory renal artery. It seems that the presence of accessory renal arteries does not affect the prognosis of the disease.

Predictors of renal angioembolization outcome: A retrospective analysis with 148 patients at a tertiary urology institute

ObjectiveThe aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization (RAE). Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects, while helping to prepare for an alternate procedure and improving patient's overall satisfaction. MethodsA retrospective analysis between January 2006 and December 2018 was performed, and the indications for RAE were classified into post-traumatic, iatrogenic, renal tumors, and spontaneous. Patients who underwent RAE prior to nephrectomy were eliminated. Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy, otherwise magnetic resonance angiography was performed. For the purpose of statistical analysis, we stratified patients into two main categories based on the final outcome—successful or failed. ResultsOf 180 patients, 32 with negative angiography were eliminated, leaving 148 patients; 136 (91%) had successful outcomes after one or more trials and 12 had unsuccessful outcomes. The mean age was 45±15 years, and 105 (71%) were male. Neither gender, side of the lesion, presence of hematuria, indication for RAE, nor the type of lesion affected the outcome. On the other hand, renal anatomy with presence of accessory artery was the only predictor to failed RAE (p=0.001). Failed RAE trial was a predictor for nephrectomy as a secondary procedure (p=0.03). ConclusionNo pre-procedural predictors could anticipate the RAE outcome, and different indications can be scheduled to RAE, which is equally effective. The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.

Society for Vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: Endoleak management

Society for Vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: Endoleak management

Renal Volumetry-based Prediction of the Presence of Accessory Renal Artery: Computed Tomographic Angiography-based Study with Clinical Implications on Renal Doppler.

Background:The objective was to validate the hypothesis and evaluate whether the presence or absence of accessory renal artery can be predicted on the basis of volumetric parameters of kidney and diameter of the main renal artery (mRA).Methods:This retrospective analysis was performed in a total of 60 kidneys in 30 patients, who had computed tomographic (CT) angiography. The kidneys were segregated into control and study groups depending on the absence or presence of accessory renal artery. The total renal volumes were measured using renal length, breadth, and height in mm3. The renal artery diameters were also measured in mm, in the postostial segment. Renal volume/renal artery diameter (V/d) was measured for each kidney in two groups, and the difference in mean V/d values (in mm2) in two groups was measured for statistical significance.Results:The mean V/d value in the study group with presence of the accessory renal artery was found to be 23,444.7 mm2 (range: 16,229.1–32,490.0). The V/d value in the control group with the absence of accessory renal artery was found to be 19,717.15 mm2 (range: 13,704.6–28,000.0). The mean values in the two groups showed a statistically significant difference in the V/d with a P value of 0.001 (P < 0.05).Conclusion:The study suggests that the possibility of the presence of the accessory renal artery is directly proportional to the total renal volume and inversely proportional to the diameter of mRA. The use of integrated volumetric parameter (V/d) is therefore likely to play a key role in the prediction of the presence of accessory renal artery on imaging studies. Renal volumetry on CT angiography may help predict the presence of accessory renal artery and thus may have implications on renal Doppler studies.

Management of accessory renal arteries during aneurysm repair in a patient with end-stage renal failure

The presence of accessory renal artery is a frequent anatomic variation that can challenge abdominal aortic aneurysm (AAA) repair. Here, we show an image of an abdominal aortic aneurysm extended to multiple accessory renal arteries in a patient known for an end-stage renal failure. This case raises the questions of the criteria that should be taken in consideration for an optimal management of accessory renal artery during AAA repair.

A computed tomography angiography study to correlate main renal artery diameter with presence of accessory renal artery in healthy live kidney donors

Introduction: The chosen technique of surgery during nephrectomy can be influenced by the sudden discovery of an aberrant source of blood supply to the kidney. Thus, a prospective study was undertaken to investigate the relationship between the diameter of the main renal artery and the presence of an accessory renal artery by computed tomography (CT)-angiography. Material and Methods: The study was conducted on 115 healthy kidney donors who presented to the department of nephrology and radiology for voluntary kidney donation. All CT examinations were performed on a 64-slice CT scanner in the arterial phase. The number of the renal arteries supplying each kidney was evaluated and their diameters were measured. Results: Eighty-six of the right side and 88 of the left side of the 115 kidneys donors had a single renal artery whereas 29 had one or more accessory renal artery (aRA) on the right side and 27 had one or more aRA on the left side. The mean diameter of mRA was 5.4 ± 1.0 mm in kidneys without aRA and 4.6 ± 10 mm in kidneys with aRA on the right side and on the left side the mean diameter of mRA was 5.59 ± 1.12 mm in kidneys without aRA and 4.7 ± 1.2 mm in kidneys with aRA. Discussion and Conclusion: The presence of additional renal arteries is very probable when the main renal artery has a diameter of 5.5 mm very probably do not present additional renal arteries. Hence, the renal artery diameter is a factor which should be considered for predicting the presence of additional renal arteries.

Anatomical study of renal and accessory renal arteries.

In recent years, more conservative methods of surgery of the renal artery are coming up. Hence, a precise knowledge of renal vasculature has become a necessity. Knowledge of the existence of accessory renal arteries is important; otherwise, they may get inadvertently damaged during renal surgery. Furthermore, their presence must be considered while evaluating a donor's kidney for possible renal transplantation. The study may also be useful to clinicians performing invasive techniques, vascular surgeries, other uro-radiological procedures, and in cases of trauma. Keeping this in mind, this study was conducted on 530 adult cadavers. A total of 1060 kidneys obtained from these cadavers were dissected and accessory renal arteries were looked for; 24.99% of the specimens showed the presence of accessory renal arteries. In 20.75%, one accessory renal artery was found, and in 4.24% of specimens, two accessory renal arteries were seen.

Accessory (multiple) renal arteries - Differences in frequency according to population, visualizing techniques and stage of morphological development.

The aim of this paper is to comprehensively analyze the literature focused on frequency of the presence of the accessory renal arteries in the human body. A systematic analysis of papers has been made. With regard to ethnicity, the incidence of accessory renal arteries fluctuates from 4% in a Malaysian population to 61.5% in a Brazilian population. The frequency is lowest in eastern and southern Asia (from 4% to 18.4%). In some, not ethnically homogenous populations, wide span of occurrence of accessory renal arteries is described (e.g. American - averaging from 18% to 28.8%). A higher frequency of accessory renal arteries was observed in fetuses compared to adults. Moreover, differences in the presence and number of accessory renal arteries reported in different papers are a consequence of type of visualizing technique used in research - especially when computed tomography and anatomical dissection were compared. The increasing number of surgical interventions, especially where laparoscopic methods are concerned, underlines the importance of such knowledge especially to surgeons, interventional radiologists, nephrologists, and vascular surgeons.

Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries.

Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.

Impact of kidney ischemic lesions on renal function after fenestrated endovascular repair

Fenestrated endovascular aortic repair (fEVAR) is being used increasingly in the treatment of complex aortic aneurysms; however, this procedure can be associated with visceral and renal complications. Because the causes of possible renal function (RF) impairment have not been fully examined yet, we conducted a study to investigate whether there are risk factors associate with renal ischemic lesions (RILs) and if they influence RF in patients treated for complex aortic aneurysm with fEVAR. We evaluated the clinical, anatomic, and technical characteristics of consecutive patients treated with fEVAR from 2008 to 2014. RIL were identified by postoperative computed tomography angiography and the volume of renal parenchyma involved quantified. A decrease in RF (>30% glomerular filtration rate reduction) was evaluated at discharge, and at the 6- and 12-month follow-ups. Among 53 patients, we analyzed 38 (72%) juxta/pararenal and 15 (28%) thoracoabdominal aortic aneurysms (33 [64%] with ≥3 fenestrations) and 102 renal arteries. Fifteen patients (30%) showed RIL, which was caused by accessory renal artery (ARA) coverage in 6 cases (38%), distal embolism in 6 (38%), renal artery thrombosis in 2 (18%), and iatrogenic embolization for intraoperative bleeding during fEVAR in 1 (6%). The volume of renal parenchyma involved was less than 25% in 10 (67%) and 25% to 50% in 5 (33%) cases. In no cases was more than 50% renal volume affected. On multivariate analysis, RIL predictors were the presence of ARA (odds ratio [OR], 8.00; 95% confidence interval [CI], 1.16-54.89; P = .03) and extensive thrombosis of the pararenal aorta (OR, 39.93; 95% CI, 3.36-474.23; P = .003). At discharge, chronic renal failure (CRF; OR, 4.80; 95% CI, 1.27-18.09; P = .01), diabetes (OR, 8.44; 95% CI, 1.33-53.51; P = .01), and extensive thrombosis of the pararenal aorta (OR, 5.50; 95% CI, 1.32-29.92; P = .01) were significantly associated with worsening RF. RIL, independent from volume, did not influence the postoperative RF. At 6 months and 1-year, preoperative CRF and perioperative declines in RF were identified as the only risk factors for worsening RF. RIL is a common fEVAR complication and is primarily owing to ARA coverage and aortic thrombus embolization. However, RIL does not influence RF, which is predicted by preoperative CRF, diabetes, and extensive aortic thrombus.