Presence Of Multiple Renal Arteries Research Articles

Retrospective analysis of the perioperative outcome in living donor kidney transplantation with multiple renal arteries: does accessory vessel ligation affect the outcome?

PurposeAccurate surgical reconstruction of arterial vascular supply is a crucial part of living kidney transplantation (LDKT). The presence of multiple renal arteries (MRA) in grafts can be challenging. In the present study, we investigated the impact of ligation versus anastomosis of small accessory graft arteries on the perioperative outcome.MethodsClinical and radiological outcomes of 51 patients with MRA out of a total of 308 patients who underwent LDKT with MRA between 2011 and 2020 were stratified in two groups and analyzed. In group 1 (20 patients), ligation of accessory arteries (ARAs) and group 2 (31 patients) anastomosis of ARAs was performed.ResultsSignificant differences were observed in the anastomosis-, surgery-, and warm ischemia time (WIT) in favor of group 1. Students t-test showed comparable serum creatinine levels of 2.33 (± 1.75) to 1.68 (± 0.83) mg/dL in group 1 and 2.63 (± 2.47) to 1.50 (± 0.41) mg/dL in group 2, were seen from 1 week to 1 year after transplant. No increased rates of Delayed graft function (DGF), primary transplant dysfunction and transplant rejection were seen, but graft loss and revision rates were slightly higher when the ARAs were ligated. Analysis of Doppler sonography revealed that segmental perfusion deficits tend to regenerate during the clinical course.ConclusionLigation of smaller accessory renal arteries may not affect the outcome of living kidney transplantation, except for a minor increase in the reoperation rate. Segmental perfusion deficits of the graft seem to regenerate in most cases as seen in Doppler sonography.

RIGHT PUJ NARROWING CAUSED BY RIGHT ABERRANT RENAL ARTERY : A CASE REPORT

Ureteropelvic junction obstruction is usually intrinsic and is most common in children. Multiple renal arteries have been reported to occur in approximately 30% of cases( with a preponderance on the left side. With respect to the presence of multiple renal arteries, by a study of Sampaio et al.9), an inferior “accessory” or “aberrant” artery was found to cross anteriorly to the UPJ in 6.8% of the cases. In few specimens this inferior accessory artery pass close to the UPJ. Therefore, the presence of an anomalous vessel crossing the UPJ and causing obstruction is a very rare finding). Aberrant renal arteries to the inferior pole cross anteriorly to the ureter and may cause hydronephrosis. We describe a 52-year-old woman with hydronephrosis due to UPJ obstruction by an aberrant renal artery and review the literature in brief.

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.

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.

Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy.

Background and PurposeVascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN).Patients and MethodsData from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations.ResultsMRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively.ConclusionHALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.

Rutin bilgisayarlı tomografi incelemelerinde renal vasküler varyasyonların değerlendirilmesi

Aim: Anatomical variations of the kidney, including multiple renal arteries are crucial for renal and abdominal aortic surgery and renovascular hypertension. In this study, we aimed to investigate the frequency of multiple renal arteries in a Turkish population by evaluating the images of patients who underwent contrast-enhanced computed tomography (CT) for various reasons.Material and Methods: Images of patients who underwent contrast abdominal computed tomography in our hospital due to various health problems were evaluated retrospectively. The presence, number, and exit levels of multiple renal arteries were examined.Results: In the study, CT scans of 470 patients, aged between 18 and 69 years (43.7 ± 14.1) were analyzed retrospectively. Of the 940 kidneys evaluated, 113 had multiple renal arteries. Of the multiple renal arteries, 59 belonged to women and 54 to men, and the difference was found to be statistically insignificant. The incidence of multiple renal arteries was determined as 20.6% in evaluated cases and 12% in evaluated kidneys. The number and frequency of occurrence is 53 (47%) in the right kidney and 60 (53%) in the left kidney, respectively, and there is no significant difference between the two sides. Accessory renal arteries originated from the abdominal aorta between lumbar 1 vertebra (L1) and L4, except for 2 cases where they originated from the iliac artery.Conclusion: The incidence of multiple renal arteries in the Turkish population was found at rates similar to the literature, using CT. CT is found to be a reliable method in detecting multiple renal arteries. Considering the presence of multiple renal arteries in CT examinations, we think that valuable information can be obtained in the investigation of renovascular hypertension.

Correlation Between the Mayo Adhesive Probability Score and the Operative Time in Laparoscopic Donor Nephrectomy

BackgroundAdherent perinephric fat (APF) is a known risk factor of surgical difficulty during laparoscopic donor nephrectomy (LDN). The Mayo Adhesive Probability (MAP) score predicts APF accurately. The aim of this study is to identify the association between MAP score and operative time in LDN. MethodsWe retrospectively evaluated 154 kidney donors who underwent surgery from December 2017 to December 2019 at İstanbul Aydın University Hospital and İstinye University Hospital. All of the operations were done by 3 senior surgeons by a fully laparoscopic method. The MAP score was derived from computed tomography scans by 1 blinded reader. Demographic data, body mass index (BMI), MAP score, side selection, estimated glomerular filtration rate (eGFR), number of arteries and veins, operative time, hospital stay, and complications are recorded. Single and multiple variable analyses were used to evaluate the correlation between operative time and MAP score, BMI, side selection, and number of vascular structures. ResultsA total of 154 patients (79 men, 75 women) with a mean age of 44.4 ± 12.72 were included in this study. None of the cases were converted to open nephrectomy. There were no major complications. Mean BMI was 27.59 ± 4.32 kg/m2, mean MAP score was 0.69 ± 1.15, and mean operative time was 40.25 ± 9.81 minutes. Although mean BMI was higher in women (28.19 ± 4.52 vs 27.03 ± 4.07; P < .05), mean MAP score was lower than in men (0.35 ± 0.86 vs 1.03 ± 1.29; P < .001). Older age, higher BMI, higher MAP score, and presence of multiple renal arteries were associated with longer operative time of LDN. The MAP score was associated with older age, male sex and higher BMI. ConclusionsThis study showed that different risk factors can affect operative time in LDN. The MAP score was significantly associated with longer operative time, especially in men, so it can be useful for predicting surgical difficulty in kidney donors.

THE PREVENTIVE EFFECT OF SIROLIMUS ON URETERAL STRICTURE FORMATION

Introduction: Stricture of the transplant kidney ureter occurs in approximately 3% of transplant recipients. Risk factors for ureteral stricture include kidneys coming from marginal donors with advanced age and multiple comorbidities. Additionally, delayed graft function, presence of multiple renal arteries and direct injury during retrieval may increase the risk of this complication. Its clinical presentation is typical with elevated serum creatinine accompanied by hydronephrosis. Although several open and endoscopic techniques have been described to manage this condition, ureteral stricture still increases short and long-term graft loss significantly. An M-TOR inhibitor Sirolimus has been shown to reduce fibrosis. Since the mechanism of stricture formation is also through fibrosis, we analyzed the effect of this immunosuppressive drug on the prevention of ureteral strictures. Methods: 32 New Zealand White rabbits (2500-3000grams) were used in the study. The rabbits were randomly assigned into four groups (n=8). Group 1: A unilateral nephrectomy and subsequent full transection of the contralateral ureter was performed. The transected ureter was reconstructed over a double J ureteral stent by using interrupted 7/0 PDS stitches. Group 2: Same procedure with group 1 with Sirolimus- impregnated (1mg) stent placement Group 3: A unilateral nephrectomy and subsequent full transection of the contralateral ureter was performed. The transected ureter was reconstructed without a stent and 1 ml of saline was instilled over the anastomosis. Group 4: Same with group 3 with 1ml (1mg/ml) of Sirolimus solution instilled over the ureteric anastomosis (Figure 1). On postoperative day 3, serum creatinine levels were measured. On postoperative day 7, an ultrasound of the kidney was performed to evaluate hydronephrosis. On postoperative day 21, all rabbits were explored to evaluate the ureteral anastomosis. Subsequently, all subjects were terminated, and full segment of the ureter was removed for histopathology assessments and tissue hydroxyproline level measurements. Results: Severe hydronephrosis and creatinine elevation were observed in group 3 compared to other groups (Figure 2). Histopathological evaluation of the specimens showed increased fibrosis scores in groups 1 and 3 (Figures 3&4). Tissue hydroxyproline levels in group 4 were found to be lower compared to other groups. Conclusion: Sirolimus-impregnated double J stents may decrease ureteric stricture formation. This effect can be beneficial both in both kidney transplant and endourology practice.Fig. 1.Fig. 2.Fig. 3.

Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels.

Introduction:In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN.Materials and Methods:Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed.Results:Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group (P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13).Conclusion:The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.

Unenhanced magnetic resonance angiography as an accurate alternative in the preoperative assessment of potential living kidney donors with contraindications to computed tomography angiography and to contrast-enhanced magnetic resonance angiography.

ObjectiveTo evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard.Materials and MethodsThis was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement.ResultsThe image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%.ConclusionUnenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.

Geographic Distribution of Multiple Arteries and Veins of 878 Kidney Donors From a Transplant Center in Turkey

AimThe diagnosis and management of multiple renal arteries and veins have gained importance with the increasing number of kidney transplantations and improved techniques in interventional radiology and vascular reconstructions. The aim of this study is to define and to detect the rate of multiple renal arteries and veins in our living kidney transplant donors coming from all parts of our country. MethodsAbdominal computed tomography angiogram findings of 878 kidney transplant donors were analyzed. The presence and the distribution of multiple renal arteries and veins in donors coming from 7 geographic regions in Turkey were noted. ResultsThe presence of multiple renal arteries was observed in 34% (48/141) of patients in the Marmara Region, 36.7% (79/215) of patients in the Black Sea Region, 37.2% (64/172) of patients in the Central Anatolia Region and 36.1% (30/83) of patients in the Southeastern Anatolia Region. The highest incidences of multiple renal arteries were observed in the Mediterranean and Aegean regions, affecting 40% (32/80) and 41.9% (26/62) of patients, respectively, while East Anatolia was found to have the lowest incidence, affecting 28% (35/125) of patients. The incidence of multiple renal veins also varied across regions. The highest incidence was observed in the Central Anatolia Region, where 23.3% (40/172) of patients were affected; the lowest was seen in the Aegean Region, where 11.3% (7/62) of patients were affected. In Turkey as a whole, 35.8% (314/878) of patients presented with multiple renal arteries, while the rate of multiple renal veins was found to be 19% (167/878) among our donors. ConclusionsAs 80% of the kidney transplantations performed in Turkey involve living donors, we think it will be useful to have knowledge of not only the presence of multiple renal arteries and veins, but also the distribution of this feature throughout the different regions of the country.

Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study

Introduction: The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. Despite concerns about risks, these allografts are being increasingly used to overcome a shortage of renal donors. Objectives: To compare the outcomes of live-donor renal allografts with multiple and single renal arteries (SRA) in terms of overall ischemia times, early and late graft function, and vascular and urological complications. Methods: A prospective, non-randomized cohort study was conducted including all live donor renal transplants done by the Vascular and Transplant Unit of the National Institute of Nephrology Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312 recipients of live donor renal allografts were recruited to the study. Patients were divided into three groups: Group 1—SRA: single anastomosis (n = 264, 85%); Group 2—MRA: single conjoined anastomosis (n = 39, 12%); and Group 3—MRA: ≥2 anastomoses (n = 9, 3%). Results: Mean ischaemia times (donor clamping to graft reperfusion) in the three groups were 14, 21 and 17 minutes respectively. Failure to normalize creatinine within 72 hours was seen in 29/264 (11%), 4/39 (10.2%) and 1/9 (11%), (P >0.05). Delayed graft function (attributable to severe rejection) occurred in only one patient who was from group 2. One-year graft survival among the groups was 243/264 (92%), 35/39 (90%) and 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed transplant renal artery stenosis. Two patients from group 1 needed stenting for ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted safely with careful surgical reconstruction and close surveillance post-transplant.

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries

BackgroundAn in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries.Materials and methodsComputed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply.ResultsThe frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219).ConclusionsThe classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.

Vascular Augmentation in Renal Transplantation: Supercharging and Turbocharging.

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as ‘supercharging’ and ‘turbocharging,’ have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.

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.

Secondary hyperaldosteronism, caused by abnormalities of the renal vessels, in clinical endocrinologist

Aldosterone levels increase in clinical practice may be due to primary or secondary hyperaldosteronism. Secondary hyperaldosteronism (CAA) is a clinical syndrome caused by increased synthesis of renin juxtaglomerular apparatus of the kidneys in response to lower perfusion pressure in the afferent glomerular arteriole. This mechanism leads to activation of the renin-angiotensin-aldosterone system with a consequent increase in systemic blood pressure. Clinically manifested CAA secondary (systemic) arterial hypertension, the most common form of parenchymal renal disease and renal vascular lesions. Renovascular diseases are a heterogeneous group of pathologies, which includes atherosclerosis of renal arteries, the most common cause; fibromuscular dysplasia (FMD); other more rare diseases, accompanied by a narrowing of the lumen of the renal vessels. Some authors consider the possibility of including a group of renovascular disease presence of multiple renal arteries. Тhe article presents the clinical cases of secondary hyperaldosteronism, caused by FMD and abnormal amounts of the renal arteries, manifested hypertension and increased levels of aldosterone in the blood. Carrying out a detailed search of the diagnostic determination of the ratio of aldosterone to plasma renin helped eliminate endocrine genesis of the disease and to identify the true cause of aldosteronism.

Bilateral renal artery variation

Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal arteryvariation. The presence of multiple renal arteries increases the complexity of the transplant surgery procedures

Outcome of Living Related Renal Grafts With Multiple Arteries -A Single Center Experience From a Developing Country.

Purpose: This study report the outcome of renal allograft with multiple arteries and the complication encountered in a developing country setting. Material & Method: Between 1995 and 2012, 3442 live related transplant were performed at our center. Of these 256 had multiple arteries. Implantation was by double barrel with side to side anastomosis using 7/0 non absorbable running sutures. In some cases end to side anastomosis was performed. Most of the graft renal arteries were anastomised with external iliac artery in end to side fashion using 6/0 non-absorbable running sutures. Ureter was anastomised with urinary bladder in extravesical Lich-Gregoir Technique. DJ stents were placed in some cases. All patients received a cyclosporine based triple during regimen. The outcome of recipients with multiple arteries grafts were compared with age, gender and transplant period matched controls with single vessels transplanted in the same period. Results: of the 3442 live related transplants 256 (7.5%) graft had multiple arteries. The mean age of the recipient was 29.6 + 9.7 with a M:F ratio of 3.4:1. Of the 256 grafts 241 (94%) had double, 14 (5.4%) triple and 1 (0.4%) five vessels. Delayed graft function was observed in 35 (13.6%). Complications were encountered in 6 (2.3%). Re-exploration in 2, re-implantation of ureter in 2, re-implantation in 1 and primary non function in 1. Acute rejection rates were 13% in multiple artery cased vs 11% in controls. One and five year graft survival in multiple artery cases was 96% and 85% vs 96% and 83% respectively in controls. Conclusion: The outcome of graft with multiple arteries was similar to the control group with single artery. The presence of multiple renal arteries in kidney grafts should not be considered a risk factor for graft outcomes.

Multiple renal arteries with renal cell carcinoma: Preoperative evaluation using computed tomography angiography prior to laparoscopic nephrectomy

To investigate anatomical variations in the renal arteries of patients with renal cell carcinoma (RCC) using computed tomography angiography (CTA). Patients diagnosed with RCC were evaluated using CTA prior to undergoing laparoscopic nephrectomy. Any anatomical variations of the renal arteries on the side affected by the RCC were recorded. The CTA results were compared with the observations made during surgery and those produced by conventional digital subtraction angiography. A total of 107 patients with RCC were enrolled in the study. Multiple renal arteries were found in 11 patients (10.3%). Accessory renal inferior polar arteries were the most common type of multiple renal arteries. Multiple renal arteries acting as the feeding arteries to the RCC were found in five patients (4.7%). CTA can be used as part of the preoperative evaluation prior to laparoscopic nephrectomy to provide anatomical information about the presence of multiple renal arteries in the affected kidney of patients with RCC. This could help with planning the surgery and reducing surgical complications.

Does Renal Artery Supply Indicate Treatment Success of Renal Denervation?

Renal denervation (RDN) emerged as an innovative interventional antihypertensive therapy. With the exception of pretreatment blood pressure (BP) level, no other clear predictor for treatment efficacy is yet known. We analyzed whether the presence of multiple renal arteries has an impact on BP reduction after RDN. Fifty-three patients with treatment-resistant hypertension (office BP ≥ 140/90 mmHg and 24-h ambulatory BP monitoring (≥130/80 mmHg) underwent bilateral catheter-based RDN. Patients were stratified into one-vessel (OV) (both sides) and at least multivessel (MV) supply at one side. Both groups were treated on one vessel at each side; in case of multiple arteries, only the dominant artery was treated on each side. Baseline clinical characteristics (including BP, age, and estimated glomerular filtration rate) did not differ between patients with OV (n = 32) and MV (n = 21). Office BP was significantly reduced in both groups at 3 months (systolic: OV -15 ± 23 vs. MV -16 ± 20 mmHg; diastolic: OV -10 ± 12 vs. MV -8 ± 11 mmHg, both p = NS) as well as 6 months (systolic: OV -18 ± 18 vs. MV -17 ± 22 mmHg; diastolic: OV -10 ± 10 vs. -10 ± 12 mmHg, both p = NS) after RDN. There was no difference in responder rate (rate of patients with office systolic BP reduction of at least 10 mmHg after 6 months) between the groups. In patients with multiple renal arteries, RDN of one renal artery--namely, the dominant one--is sufficient to induce BP reduction in treatment-resistant hypertension.