Single Renal Artery Research Articles

PP.25.20] THE CHARACTERISTICS OF EARLY CHANGES IN BLOOD PRESSURE AFTER RENAL DENERVATION

Objective: Renal denervation (RDN) has been shown to reduce office blood pressure (BP) and target organ damage in patients with resistant hypertension (RHpt). We aimed to investigate the characteristics of early changes of BP in RHpt undergoing RDN and the predictors of ambulatory blood pressure monitoring (ABPM) response after RDN in one Hypertension unit in Croatia. Design and method: From a total of 957 patients in Hypertension unit, during 12 months, only refractory RHpt (105) were included in study, from which 10.4% (12pt) have criteria for RDN (Symplicity TM RDN System, 5F/6F quide catheter, five to seven nerve ablations were performed on each side without any complications) and were followed before and after RDN (age 62 ± 6 years, 6.7 ± 1 for number of antihypertensive drug classes included aldosterone use in doses from 50–100 mg, BMI 35 ± 3 kg/m2, estimated GFR 65 ± 28 mlmin-11.73m2.). ABPM was measured at baseline and one day after RDN in 12 patients with RH and single renal arteries bilaterally: 9 without special anatomical constellations (group1) and 3 patients with special anatomical constellations (group 2). All 12 patients completed renin at baseline and follow-up and were without changing of medication at six months after RDN. Results: The majority of RHpt (90%) had chronic hypertension (cH) more than 10 years, while 10% had diagnosed hypertension less than one year (nRH). Patients with cH compared to patients nH were older (p < 0.001), had higher BMI (p < 0.001), higher systolic BP and lower estimated GFR (56 ± 17 vs 79 ± 13 ml min-1 1.73m-2, p < 0.001). RDN significantly reduced ABPM in group 1 at one day after RDN from max average 224/124mmH before RDN to minimal average 134/77 mmHg after RDN (P < 0.001), and in group 2 from max average 221/130 mmHg before RDN to minimal average 129/80 mmHg after RDN (P < 0.001). Significant reduction in resting baseline renin level was observed in group 1 (P < 0.001) and 2 (P < 0.05) after 1 month follow up. Conclusions: If sufficient renal sympathetic nerve ablation were performed and without changing of medication RDN significantly reduced ABPM one day after RDN.

Morphological Variations of Posterior Segmental Artery of the Single Renal Artery. Study on corrosion casts

On a total of 150 renal corrosion casts were examined the posterior branch and the artery of renal posterior segment. For the origin of the posterior branch, there have been highlighted three morphological types, namely: Type I, bifurcation in anterior and posterior branches (92.67% of cases); Type II, trifurcation in anterior, posterior and superior or inferior branches (6.00% of cases); Type III, quadrifurcation in anterior, posterior, superior and inferior branches (1.33% of cases). Depending on the relations between this path and those with the posterior aspect of the renal pelvis, we highlighted four morphological types: Type I (62.67% of cases) with large extension of the posterior segmental artery, convex downward path and multiple subsegmentary branches; Type II (34.00% of cases) with large extension of the posterior segmental artery, that bifurcates or trifurcates in segmental branches and convex downward path; Type III (2.00% of cases) with small extension of the posterior segmental artery, with downward path in relation to the upper portion of the posterior surface of the renal pelvis upper portion; Type IV (1.33% of the cases) with small extension of the posterior segmental artery, with upward trajectory in relation to the lower portion of the renal pelvis. Knowledge of these aspects is important both to investigate morphological imaging and for performing partial resection of the renal parenchyma.

A retrospective study to assess the evaluation of living related kidney donors and their outcomes following nephrectomy at Kenyatta National Hospital

BackgroundKidney transplantation is the renal replacement therapy of choice for end stage renal disease. To ensure safety regular audit of the donation process is necessary. The aim of this study was to assess the evaluation of potential living related kidney donors and document their outcomes following nephrectomy.MethodsThis was a retrospective descriptive study involving all living related kidney donors seen at Kenyatta National Hospital (KNH) renal unit from 2010 to 2014.Upon approval by KNH/ERC, the records of all kidney donors were retrieved. Demographic characteristics, number of potential and actual donors, their clinical, laboratory and radiological data as well as documented complications and deaths were recorded. SPSS version 17(Chicago, Ilinois) was used for data entry and analysis. Chi square test and Mann Whitney U test were used as tests of association for categorical and continuous data respectively, with P value set at <0.05.ResultsMedian age of the donors was 34 years (IQR 31–39). First-degree relatives were majority(84.5%). Renal function assessment was done using mean glomerular filtration rate (GFR) from the radionuclide scan (DTPA) and serum creatinine levels. The donors had a mean GFR of 99.2 ± SD 6.6. All the haematological and biochemical tests were within normal. Majority(42.9%) were HLA compatible, but data on HLA typing was missing for 22% of the patients records. On CT angiogram, single renal artery and single renal vein were found in 94 and 88% respectively. Immediate complications included excessive bleeding(2%) and breach of other cavities (4%). Paralytic ileus (32%) and atelectasis (27%) were the most common early postoperative complications. There was no mortality.ConclusionOur study reports no fatality but significant post-operative complications. These are significant findings that may be used to review and improve care and to educate potential kidney donors on the safety of this procedure in our centre, in a bid to widen the pool of potential living kidney donors.

Blood pressure reduction in patients with accessory renal arteries and bilateral single renal arteries after catheter-based renal denervation: a prospective study with 3-year follow-up.

Catheter‑based renal denervation (RD) is an effective treatment leading to a significant reduction of systolic and diastolic blood pressure (BP) in patients with resistant hypertension. The aim of this prospective study was to assess the BP-lowering and pulse pressure (PP)- lowering effects in patients with accessory and bilateral single renal arteries after catheter‑based RD during a 3‑year follow‑up. The study included 31 patients with diagnosed resistant hypertension. Patients were classified into 2 groups: group 1 included patients with accessory renal arteries, and group 2, with bilateral single renal arteries. The BP and PP reduction levels were measured before the procedure and at 6, 12, 24, and 36 months after the procedure. All procedures were successful. In group 1, mean systolic BP, diastolic BP, and PP at baseline were 172.7 mm Hg, 98.9 mm Hg, and 74.4 mm Hg, respectively. Systolic BP, diastolic BP, and PP reduction levels were, respectively, -26.9, 19.2, and 7.5 at 6 months; -33.3, 16.1, and 16.4 at 12 months; -29.2, 14, and 18.2 at 24 months; and -28.6, 13.6, and 13.7 at 36 months. In group 2, mean systolic BP, diastolic BP, and PP at baseline were 175.6 mm Hg, 100.1 mm Hg, and 75.5 mm Hg, respectively. Systolic BP, diastolic BP, and PP reduction levels were, respectively, -26, 10.5, and 15.5 at 6 months; -22, 8.9, and 13 at 12 months; -28, 12.4, and 15.6 at 24 months; and -24.6, 14.97, and 9.2 at 36 months. Significant reductions were observed for systolic BP in group 1 and for PP and systolic and diastolic BP in group 2. RD successfully reduced systolic BP in patients with resistant hypertension and accessory renal arteries. PP reduction after RD in patients with accessory renal arteries was less pronounced than in patients with bilateral single renal arteries.

V6-04 RETROPERITONEAL COMPARTMENT SYNDROME IN RENAL TRANSPLANTATION—HOW DO WE SALVAGE THE GRAFT?

You have accessJournal of UrologyMisc. GU Oncology and Transplant1 Apr 2017V6-04 RETROPERITONEAL COMPARTMENT SYNDROME IN RENAL TRANSPLANTATION—HOW DO WE SALVAGE THE GRAFT? Wen Xie, Karen Pineda-Solis, Omar Ali, Alp Sener, and Patrick Luke Wen XieWen Xie More articles by this author , Karen Pineda-SolisKaren Pineda-Solis More articles by this author , Omar AliOmar Ali More articles by this author , Alp SenerAlp Sener More articles by this author , and Patrick LukePatrick Luke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1579AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Early allograft dysfunction (EAD) can be caused by a number of technical factors including vascular complications such as thrombosis and kinking. Retroperitoneal compartment syndrome (RACS) is an under-recognized vascular cause of EAD with potentially devastating consequences, and may even result in a lost graft. The graft can be salvaged with early recognition and intervention through a mesh hood fascial closure (MHFC) technique. METHODS Here we describe, in video, a 23-years-old male recipient diagnosed with renal failure secondary to chronic reflux. He has a 6 months history of peritoneal dialysis and is currently on hemodialysis. The patient received an anonymous living-donor right kidney from our paired exchange program. His BMI is 22. The graft had a single renal artery and single renal vein. A standard anastomosis was performed and subsequent urine output was brisk. The fascia was closed without tension. However, urine production ceased after the fascia was fully closed. A case of RACS was suspected and intraoperative Doppler ultrasound showed no blood flow in the graft. Immediately re-exploration revealed the graft to be abnormal in color and turgor. RESULTS These abnormalities resolved after pressure was relieved. The kidney was then placed in the optimal position within the iliac fossa and a large ellipsoid piece of polypropylene mesh was draped loosely and without tension over the graft. The mesh was attached to the posterior fascial edges using interrupted #1 polypropylene sutures. Skin closure then was completed over a closed suction drain placed in the retroperitoneal space lateral to the kidney. Doppler ultrasound after skin closure showed good flow and the postoperative course was unremarkable. CONCLUSIONS RACS could be associated with small android pelvis and lack of compliance in the retroperitoneal cavity secondary to peritoneal dialysis. Suspected RACS require prompt intervention to prevent irreversible graft dysfunction. We have shown that MHFC is an effective and safe method to treat EAD secondary to RACS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e680 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Wen Xie More articles by this author Karen Pineda-Solis More articles by this author Omar Ali More articles by this author Alp Sener More articles by this author Patrick Luke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Endovascular Management of Proximal Fixation Loss Using Parallel Stent Grafting Techniques to Preserve Visceral Flow

Proximal fixation loss following endovascular aortic aneurysm repair (EVAR) creates a clinical dilemma. Typically, endovascular salvage requires adequate aortic neck below the renal arteries, in cases with no infrarenal neck proximal extension into the paravisceral aorta using parallel grafts provides an alternative to open graft explant. We present our experience at a tertiary care center with endovascular management of proximal fixation loss following EVAR using parallel stent grafting techniques to preserve renal and visceral branches. We conducted a retrospective review of our type I endoleak database. Of 135 patients, 19 patients were identified that required Ch-EVAR as a salvage procedure for loss of proximal fixation or seal after a previous EVAR. Data from all procedures, as well as the entire hospital course, and documented follow-up were captured and analyzed. The average age of the cohort was 83 (78-88) years. The average time from original EVAR to secondary treatment was 6.05years. The most common primary endograft treated was the AneuRx stent graft at 37% (n=7). Ninety-five percent of patients were treated for an expanding aneurysm sac with 21% of patients being symptomatic at the time of treatment. Open femoral access was used more commonly than a percutaneous approach (n=14 vs. 5). Adjunctive proximal arterial access was required in 58% of cases; open axillary exposure (n=4), percutaneous brachial (n=4), and open brachial (n=3) access. Eighteen patients received proximal cuffs in addition to parallel stent grafts, whereas 1 patient required an entire endograft relining in addition to the parallel visceral stents. Twenty-nine total parallel stent grafts were placed, most commonly in a single renal artery (n=27). Primary technical success was achieved in 100% of cases with exclusion of all type IA endoleaks. Reintervention was required for 1 patient for a new type III endoleak. There was an average follow-up time of 520.5days with 100% snorkel patency. Although technically challenging, endovascular salvage of proximal fixation failure after EVAR is possible with extension to the paravisceral aorta using parallel graft techniques. Parallel chimney stent treatment for proximal fixation failure following EVAR can be performed with high technical success, low need for reintervention, and excellent midterm patency rates. Given these findings, chimney stent treatment should be considered the primary mode of therapy for those patients with limited life span and extensive medical comorbidities.

Laparoscopic Donor Nephrectomy of Dual Renal Artery Kidneys: Single Center Experience

This study aims to evaluate both donors and recipients outcomes of laparoscopically procured dual renal artery (DRA) kidneys. Patients and Methods: We reviewed the medical records of all living kidney donors who underwent laparoscopic donor nephrectomy between April 2009 and December 2014, and their recipients. Operative details and immediate outcomes of both donors and recipients of DRA kidneys were compared to those of donors and recipients of single renal artery (SRA) kidneys. Results: From a total of 250 laparoscopic donor nephrectomies, 43 (17.2%) were on kidneys having DRAs. The mean operative time was statistically higher in the group with DRA (168.1 mins vs 135.3 mins, p=0.001), however, mean warm and cold ischemia times were the same. There were no complications reported among donors in neither groups, nor conversion to open nephrectomy. Lengths of hospital stay of the donors were similar in both groups. There was no statistically significant difference in immediate allograft function among the two groups. Conclusions: Laparoscopic procurement of kidneys with dual renal arteries is safe, reliable, and has no significant impact on the neither donor's outcome, nor allograft function.

Multiple Renal Arteries in Kidney Transplantation: A Systematic Review and Meta-Analysis

The use of grafts with multiple renal arteries (MRA) in renal transplantation has not been clearly established. A systematic literature review used predefined terms to search PubMed, EMBASE, and the Cochrane Library for all studies since 1985 that included more than 50 MRA grafts. A total of 23 studies, comprising a total of 18,289 patients, were eligible to be included in the meta-analysis. Patients who received an MRA graft compared to single renal artery (SRA) grafts showed significantly higher complication rates (13.8% vs. 11.0%, OR 1.393, p<0.0001), more delayed graft function (10.3% vs. 8.2%, OR 1.333, p=0.022), and had an associated significantly lower 1-year graft survival (93.2% vs. 94.5%, OR 0.819, p=0.034). Both the creatinine level and the warm ischemia time (WIT) were significantly higher in patients with MRA grafts but showed high heterogeneity (I² 98% for WIT and I² 70% for creatinine level). Although MRA grafts were associated with more complications compared to SRA grafts, long-term outcomes were similar for 5-year graft survival (81.4% vs. 81.6%) and 1- and 5-year patient survival (95.4% and 89.6% in MRA group vs. 95.4% and 87.0% in SRA group, respectively). MRA grafts were associated with a higher risk of complication and delayed graft function but had comparable long-term outcomes for graft and patient survival.

Anatomical Study of Renal Arteries

Arterial supply of the kidney is by the Renal artery. These renal arteries are the Antero lateral branches of the abdominal Aorta at the L1 to L2 Inter vertebral disc level. During the dissection of Cadavers in the department of anatomy we observed more than one arterial supply to the kidney and a number of renal arteries showing early ramification before entering into the hilum of kidney. As per our study 70% of the kidneys are irrigated by single renal artery and 20 % irrigated by the extra renal arteries and 10% specimens showing early ramification. Variations in renal arterial pattern is more common. So it is useful to have awareness to prevent the surgical hazards because of anatomical consideration.

Supernumerary renal vessels: analysis of frequency and configuration in 996 computed tomography studies.

Number, course and division pattern of renal vessels is highly variable. Variant renal vasculature is of high interest in nephrectomy for the renal transplantations, both in deceased and living donors. The purpose of the study was to analyse the frequency of supernumerary renal vessels in a large cohort of patients undergoing the multiphase abdominopelvic computed tomography (CT), as well as analyse the possible patterns of coexisting supernumerary arteries in veins. A retrospective analysis of abdominopelvic CT studies within 1 year period was performed. In each study, number of renal arteries and veins was recorded. Course of left renal vein was classified into normal, retro- or periaortic. For statistical analysis of normal distribution data, t-Student test was used. Chi-square test was used for frequency of variant vessel distribution. Pearson correlation coefficient was used for the analysis of coexistence of supernumerary vessels. 996 patients were included in the analysis, male to female ratio: 481:515 (48%:52%). Mean age was 57.9 ± 14.7 years. Single renal arteries were observed in 73% of cases, while single renal veins in 95%. Circumaortic or retroaortic courses of left renal veins were observed in 10% of cases. Number of renal vessels has been compared in patients with and without supernumerary vessels. In patients with supernumerary left renal artery, significantly more right renal vessels were observed. In patients with supernumerary right renal vein, mean number of all remaining vessels was significantly higher. Supernumerary renal vessels are a frequent finding in abdominal CT studies. Finding a supernumerary vessel should increase awareness of possible other supernumerary renal vessels.

Hand-Assisted Laparoscopic Donor Nephrectomy in Complete Situs Inversus

Complete situs inversus is a rare congenital anomaly characterized by transposition of organs. We report a case of renal transplantation using a kidney from a living complete situs inversus donor. The recipient was a 59-year-old female with end-stage renal disease because of type 2 diabetes mellitus. The donor was the 56-year-old sister of the recipient with complete situs inversus. CT angiogram of the abdomen and pelvis showed complete situs inversus and an otherwise normal appearance of the bilateral kidneys with patent bilateral single renal arteries and longer renal vein in the right kidney. The patient was taken to the operating room for a hand-assisted laparoscopic right donor nephrectomy. The patient tolerated the procedure well and was discharged home in good condition on postoperative day 1. The recipient experienced no episodes of acute rejection or infection, with serum creatinine levels of 0.8–1.2 mg/dL. Laparoscopic donor nephrectomy in a patient with complete situs inversus remains a technically feasible operation and the presence of situs inversus should not preclude consideration for living kidney donation.

A Cadaveric Study of Renal Artery Variation in Rajkot

Introduction: Renal artery is paired lateral branch of the abdominal aorta, it variates in number and origin from the abdominal aorta. Aims and objectives: This study was conducted to study and identify the incidences of renal artery variation. Material and Methods: 50 kidneys of 25 formalin fixed cadavers were dissected to study the renal artery. Observations and Results: 48% (24 out of 50 kidneys) were with single renal artery and 52% (26 out of 50 kidneys) were with multiple renal arteries. Summary and Conclusion: Renal artery variation is critical for interventions like renal artery angiogram, renal transplantation and renal surgeries, therefore the results of the studies are important for surgeon and clinicians.

Study of prehilar branching pattern of renal artery in human cadaveric kidneys

Abstract Background and aims: Kidneys are the pair of excretory organs situated retroperitoneally in the lumbar region on either side of vertebral column. Classically there is a single renal artery supplying each kidney which arises from abdominal aorta. Understanding the anatomy of vascular pattern of kidney is important for clinicians to perform renal transplantation, interventional radiological stodies. The present stody was undertaken for studying the prehilar vascular pattern of renal artery. Material and methods: Kidneys were collected from the department of Anatomy, Navodaya Medical College and Hospital, Raichur, Karnataka. Totally 84 kidneys were collected, the kidney containing full renal arteries from aorta were selected. The abnormal shaped kidneys were excluded from the stody. The blunt dissection was done to remove fat, loose connective tissue at the hilum and the artery was coloured with fabric red colour and photographed. Results: Out of 84 kidneys, single renal artery was seen in 72 cases and 12 kidney specimens showed double renal arteries. The single renal artery divided into anterior and posterior divisions. The anterior division was classified into three types of which, type I showed 43.06% incidence, type II showed 33.33% and type III showed 23.61% incidence. The posterior division was classified into two types of which type I showed 69.44% and type II showed 30.56%. Superior polar arteries were seen in 13.09% and inferior polar artery was seen in 5.95% cases. Conclusion : A sound knowledge of branching pattern of renal artery is important for urologists and radiologists for giving proper diagnosis and treatment. The present study mainly aims for prehilar vascular pattern of renal artery which may be usefull for renal transplantation and microvascular surgeries of kidneys.

A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence

IntroductionThe risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important. MaterialBetween 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively. MethodWe compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values. ResultIn the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation. ConclusionBy managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.

Variations in Branching Pattern of Renal Artery in Kidney Donors Using CT Angiography.

Each kidney is supplied by a single renal artery originating from abdominal aorta. Since there are lots of renal surgeries happening now-a-days, it becomes mandatory for the surgeons to understand the abnormality and variations in the renal vasculature. To study the variations in the branching pattern of renal artery for the presence of early division and accessory renal artery in Indian kidney donors using CT angiography. The CT angiogram images of 100 normal individuals willing for kidney donation were analysed for early divisions and occurrence of accessory renal artery. A 51% of kidney donors showed variation in the renal artery. Out of 51% variations 38 individuals had accessory renal artery and 13 individuals had early division of renal artery. The distribution of accessory renal artery was equal on both sides (13% on right and left) and 12% of individuals had accessory renal artery on both sides. Out of 13% earlier divisions, 5% was on right side, 7% was on left side and 1% was on both sides. This study concludes that 51% of kidney donors had renal artery variations. Hence, awareness of variations by evaluating the donors is a must before renal transplantation, urological procedures and angiographic interventions.

Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension

BackgroundRenal denervation (RDN) has been shown to reduce blood pressure (BP), muscle sympathetic nerve activity (MSNA) and target organ damage in patients with resistant hypertension (RH) and bilateral single renal arteries. The safety and efficacy of RDN in patients with multiple renal arteries remains unclear. MethodsWe measured office and 24-hour BP at baseline, 3 and 6months following RDN in 91 patients with RH, including 65 patients with single renal arteries bilaterally (group 1), 16 patients with dual renal arteries on either one or both sides (group 2) and 10 patients with other anatomical constellations or structural abnormalities (group 3). Thirty nine out of 91 patients completed MSNA at baseline and follow-up. ResultsRDN significantly reduced office and daytime SBP in group 1 at both 3 and 6months follow-up (P<0.001) but not in groups 2 and 3. Similarly, a significant reduction in resting baseline MSNA was only observed in group 1 (P<0.05). There was no deterioration in kidney function in any group. ConclusionWhile RDN can be performed safely irrespective of the underlying renal anatomy, the presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH. However, when patients with dual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction. Insufficient renal sympathetic nerve ablation may account for these differences.

Studies on renal arteries origin from the aorta in respect to superior mesenteric artery in Polish population.

The aim of the study was to determine the location of the branchingof the renal arteries from the aorta in respect to superior mesenteric artery. Three hundred twenty four vasculorenal samples were collected from corpses (180 male and 144 female), and subject to X-ray contrasting and preparation. The distance between the branching of selected arteries from the superior mesenteric artery (SMA) was measured. Results were subject to statistical analysis. Results were presented in group A (191/324; 58.9%) considering subjects with bilateral, single renal arteries, as well as group B (133/324; 41.1%) considering patients with multiple renal arteries. The average distance between SMA and the renal artery in group A male patients was 0.6 ± 0.57 cm, while in group B 1.3 ± 2.03 cm (p = 0.0001). In the case of female A patients, results amounted to 0.66 ± 0.58 cm and 1.12 ± 1.7 cm, respectively (p = 0.006). The above mentioned left-sided distance in male group A was 0.89 ± 56 cm, while the right-sided distance 0.73 ± 0.94 cm (p = 0.382). In female A patients 0.80 ± 0.50 cm and 0.71 ± 0.89 cm, respectively (p = 0.615). In left-sided group B male patients the distance amounted to 0.87 ± 0.70 cm, and the right-sided distance 0.71 ± 0.60 cm (p = 0.291). Considering female patients results were as follows: 0.82 ± 0.51 cm (left) and 71 ± 1.21 cm (right), respectively (p = 0.706). Knowledge of the described topography of renal artery branching from the aorta should be considered in the preoperative planning of vascular kidney system radiology examinations, as well as retroperitoneal surgical and urological procedures, especially endoscopic kidney transplantations.

Study of the outcome of renal transplants with single versus multiple renal arteries in obese recipients

As we all know, donor nephrectomy of multiple renal arteries (MRA) is not a contraindication, either by open or laparoscopic method. But the study of the effect on the recipients is still going on, and in obese patients, it is very less studied. Here we have made an attempt to study the outcome of single versus multiple renal arteries in obese patients. Graft survival and vascular and urological complications were studied and compared among the single versus multiple renal artery recipients and in obese and nonobese patients. Methods and materialRetrospectively, all the transplants done in the Department of Urology, CARE Hospital during the period of 2004–2015 were analyzed. All the patients underwent renal transplant as per hospital protocol. Statistical analysis usedData were analyzed using SPSS for Windows version 20 with relative risk calculated using stat pages software. Fisher's exact test and Kendall's tau-b were used to compare categorical data between the body mass index (BMI) and anatomical subgroups. ResultsOver all, 320 transplants were done; 224 were single renal artery (SRA) and 96 were multiple arteries. 286 had BMI <30 and 34 patients had BMI more than 30. Delayed graft function (DGF) was seen in 20 (6.25%), vascular complications in 10 (3.12%), urological complications in 15 (4.6%), wound infection in 20 (6.25%), and lymphocele in 16 (5%) was observed. Between single and multiple renal arteries, cold ischemia time, DGF, vascular complications, and one-year graft survival were suggestive of better results in SRA group. Compared to obese and nonobese single artery groups, nonobese group had better graft survival and lesser vascular complications. In multiple renal arteries also, obese patients with multiple vessel anastomosis had poor graft survival and increased vascular complications. ConclusionsEven though obesity is not a contraindication for renal transplant surgery, we need to be conscious while selecting patients with multiple renal arteries for obese recipients.

Preoperative evaluation of renal artery anatomy using computed tomography angiography to guide the superselective clamping of renal arterial branches during a laparoscopic partial nephrectomy.

The aim of the present study was to evaluate the clinical value of preoperative computed tomography angiography (CTA) imaging for guiding the superselective clamping of renal arterial branches during a laparoscopic partial nephrectomy (LPN). A total of 42 patients with renal masses of <4 cm, who had undergone a LNP, were retrospectively enrolled in the study between May 2008 and December 2013. CTA was performed preoperatively and the renal arterial anatomy was evaluated independently by two radiologists. Surgical observations, including the number, location and branching patterns of the renal arteries, were documented by the surgeon. Subsequently, the description of the renal arterial anatomy obtained using CTA was compared with the actual renal vascular structure observed during surgery. In total, 42 patients successfully underwent an LNP with superselective clamping of the renal arterial branches. The accuracy of CTA for the detection of the renal artery and renal tumor-feeding branches was 97.6 and 85.7%, respectively. The CTA images facilitated the correct identification of 36/36 single renal arteries (100%), while 5/6 renal accessory arteries were preoperatively detected using the CTA images. Statistical analyses indicated no statistically significant differences between the preoperative CTA and surgical LPN results for the number of clamped segmental arteries. Therefore, CTA was demonstrated to accurately visualize renal vascular anatomy and provide an advantage by enhancing the detection of tumor-feeding arteries. Thus, the use of CTA may facilitate improved segmental renal artery clamping during LPN.

Anatomical Variations of Upper Segmental Renal Artery and Clinical Significance.

Classically each kidney is supplied by a single renal artery. In its course renal artery divides into anterior and posterior division, both of these division further divide into segmental arteries that are apical, upper, middle, lower and posterior. Segmental arteries are representing an end artery and they form independent renal segments. In their course they are closely related with collecting system. So, a thorough in depth knowledge of the variations in segmental arteries is a basic requirement for surgeons. To observe and investigate the anatomical variations in arterial pattern of upper segmental renal artery and its relations with collecting system of ducts in human kidneys. Fifty human kidneys of both sexes were observed and studied by corrosion cast method. Different colour coded cast material (butyl butyrate) like red for artery and black for collecting ducts were used. 20% solution of butyl butyrate in acetone was injected into renal artery and ureter of the kidneys. After polymerization (24 hours) these kidneys were kept immersed in a bath of concentrated KOH solution at 50(0)C for 24-48 hours for corrosion to obtain the endocasts. These endocasts were cleaned and washed under running tap water and photographed. In present study upper segmental artery was found in 49 (98%) kidneys. It was absent in 1 (2%) kidney. We observed four types of variations in arterial pattern of upper segmental artery namely Upper Segmental Artery Type-1 (USAT1), Upper Segmental Artery Type-2 (USAT2), Upper Segmental Artery Type-3 (USAT3), Upper Segmental Artery Type-4 (USAT4) and they were found in 20 (40%), 14 (28%), 10 (20%), 5 (10%) kidneys respectively. We also observed two different variations in the anatomical relations between upper segmental artery and collecting system namely Upper Segmental Artery Group -1 (USAG1) and Upper Segmental Artery Group-2 (USAG2). USAG1 was found in 40 (80%) kidneys and USAG2 in 9 (18%) kidneys respectively. Anatomical knowledge of these variations is very important and useful for the uro-surgeons for best outcome and minimal complications in and during nephrectomies, removal of calculi, surgery of renal tumors or other various intrarenal surgeries.