Superior Renal Artery Research Articles

Variations in the Drainage Pattern of Testicular and Renal Veins, and Bilateral Duplication of Renal Arteries with Prehilar Divisions

The dissection of a 76-year-old male donor with a consent for research and publication, revealed variations of the renal and testicular vasculature where the right testicular vein joined a right accessory renal vein to form a common trunk that opened into the right renal vein. The left renal vein descended obliquely to the left ventral to the pair of left renal arteries, under crossed the prehilar branches of the arteries dorsally as it approaches the left kidney and entered the hilum posterior to the arterial branches. Both kidneys were supplied by two renal arteries (superior and inferior). The left superior renal artery followed the course of the left renal vein, crossed inferiorly ventral to the inferior renal artery, and then the last part of the left renal vein to enter the lower corner of the hilum of the left kidney. The bilaterally duplicated renal arteries broke up into anterior and posterior prehilar (early) divisions that entered the respective kidney. The co-occurrence of such multiple and complex a variation is of nephron-urological importance and can complicate nephro-surgeries, interventional radiologic procedures and the management of abdominal aortic aneurysm.

Risk factors and adverse events related to supra- and infra-renal aortic dilation at twelve months after endovascular abdominal aortic aneurysm repair.

Aortic remodeling and its effect on adverse events after endovascular abdominal aneurysm repair (EVAR) remain under investigation. This study aimed to assess aortic diameter alterations after EVAR, related risk factors and consequences to proximal sealing at 12 months. A single-center retrospective analysis of consecutive EVAR patients was undertaken. All patients underwent computed tomography angiography, preoperatively, at 1st and 12th month. The infrarenal diameter was measured just below the inferior renal artery, at 7 mm and 15 mm while the suprarenal, just above the superior renal artery (SRA), superior mesenteric artery (SMA) and just below the celiac trunk. Neck-related adverse events included migration and endoleak Ia. A hundred fifty patients were included. At 1st month, no significant diameter alteration was recorded at any level. At 12th month, all infra-renal diameters increased (P<0.001) and diameters at SRA and SMA also augmented (P=0.024 and P=0.007, respectively). Neck diameter >29 mm, supra-renal fixation and oversizing >20% were associated to dilation at 12th month. Neck adverse events were related to diameter alterations below the inferior renal artery (P=0.017), SRA (P=0.007) and SMA (P=0.05). During the 12-month follow-up, aortic dilation may be detected from the supra-renal aorta to the total neck length. Neck dilation may be attributed to large neck diameter, supra-renal fixation, and aggressive oversizing. Neck-related adverse events are more common in patients with aortic dilation at 12 months.

Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis.

Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered. Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS.Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.

Arterial reconstruction using the donor\u2019s gonadal vein in living renal transplantation with multiple renal arteries: a case report and a literature review

BackgroundArterial reconstruction is one of the paramount procedures in kidney transplantation (KT) and greatly important if the procured kidney has multiple renal arteries (MRA). Despite various established techniques for arterial reconstruction, sometimes, the surgeon finds performing arterial anastomoses challenging in case of MRA. In our case, the donor’s gonadal vein and recipient’s internal iliac artery graft were used for arterial anastomoses, and 3 years after KT, the allograft did not present vascular complications.Case presentationA 34-year-old man underwent ABO-incompatible preemptive living KT. The allograft had three renal arteries and four renal veins. After donor nephrectomy, arterial reconstruction was performed on a back table. These arteries were reconstructed into one piece using the recipient’s internal iliac artery graft. The two arteries at the middle of the renal hilum were reconstructed using the conjoined method. As the superior renal artery was too short to anastomose, the donor’s gonadal vein was used for extension. The internal iliac artery graft was anastomosed to the original internal iliac artery. Intraoperative Doppler ultrasonography revealed that the blood flow in each renal artery was adequate, resulting in sufficient blood flow throughout the allograft. The allograft function was maintained with a serum creatinine level of approximately 0.9 mg/dL without vascular complications 3 years after KT.ConclusionsThe donor’s gonadal vein can be a candidate for extension of the renal artery in the allograft with MRA. Further follow-up is needed for the assessment of long-term outcomes.

Factors influencing the operating time for single-port laparoscopic radical nephrectomy: focus on the anatomy and distribution of the renal artery and vein.

It is considered that laparoscopic single-site surgery should be performed by specially trained surgeons because of the technical difficulty in using special instruments through limited access. We investigated suitable patients for single-port laparoscopic radical nephrectomy, focusing on the anatomy and distribution of the renal artery and vein. This retrospective study was conducted in 52 consecutive patients who underwent single-port radical nephrectomy by the transperitoneal approach. In patients undergoing right nephrectomy, a 2-mm port was added for liver retraction. We retrospectively re-evaluated all of the recorded surgical videos and preoperative computed tomography images. The pneumoperitoneum time (PT) was used as an objective index of surgical difficulty. The PT was significantly shorter for right nephrectomy than left nephrectomy (94 vs. 123 min, P = 0.004). With left nephrectomy, dissection of the spleno-renal ligament to mobilize the spleen medially required additional time. Also, the left renal vein could only be divided after securing the adrenal, gonadal and lumbar veins. In patients whose renal artery was located cranial to the renal vein, PT tended to be longer than in the other patients (131 vs. 108 min, P = 0.070). In patients with a superior renal artery, the inferior renal vein invariably covered the artery and made it difficult to ligate the renal artery via the umbilical approach at the first procedure. These findings indicate that patients undergoing right nephrectomy in whom the renal artery is not located cranial to the renal vein are suitable for single-port laparoscopic radical nephrectomy.

Pitfalls in Kidney Ultrasonography: Rare Diseases

Ultrasonography (US) is well known to improve the quality of the clinical diagnosis due to its rapidity, repeatability and non-invasivity. While the physician is accustomed to frequent diseases, rare conditions may not be recognized. Our aim is to describe US images in rare kidney diseases and discuss some diagnostic implications in the detection of these pathologies. We analyzed the morphological US aspects in patients from the Nephrology Department of the Mureş County Clinical Hospital during a period of ten years. We performed a routine abdominal US for all cases. The examination was made with various US devices. The final positive diagnosis was made by clinical or other imaging modalities. We found 19 patients (0.095% of the total investigations) with specific clinical presentations and suggestive US imaging for rare renal diseases: 6 cases with medullary sponge kidney, 2 with persistence of fetal lobulation, 2 cases with hydatid cyst, 2 HIV associated nephropathies, one post-biopsy arterio-venous fistula, 2 cases with tuberous sclerosis complex, one case with superior renal artery branch stenosis, one rare mixed urothelial and sarcomatous tumor and two rare images in renal tuberculosis. For each case we described the US appearance and discussed the pitfalls that may lead to misdiagnosis. US is an important investigation in urology and nephrology. Being aware of rare diseases or rare US images is important in order to establish the final positive diagnosis and avoid unnecessary invasive and expensive procedures.

Right superior aberrant renal artery - its embryological significance

During routine dissection of an old male cadaver, in the Department of Anatomy, Pinnamaneni Siddhartha Institute of Medical science, Chinoutpalli, Andhra Pradesh, India, presence of right superior aberrant renal artery was noted. It took origin from the lateral aspect of abdominal aorta, below the origin of superior mesenteric artery and above the right main renal artery .The right superior renal artery run towards upper pole of the right kidney. Proper knowledge of variations of the arteries supplying the kidney is essential not only to the anatomists but also to the vascular surgeons, urologists, nephrologists and radiologists. Such vascular variations as noted in the present study have been explained in light of embryogenic development. DOI: http://dx.doi.org/10.3329/bjms.v11i2.11484 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 148-150

SEGMENTATION OF RENAL PARENCHYMA IN THE CASE OF PRESENCE OF ADDITIONAL RENAL ARTERIES

The presence of additional renal additional arteries represents the most often renal vascular variation. The analysis of the segmentation of the renal parenchyma renal in the case of the presence of additional renal arteries was performed on a number of 75 renal corrosion casts. The renal corrosion casts with the presence of additional renal arteries represented 20% from the whole studied trial (375 renal corrosion casts). The corrosion casts were realized by injecting the renal vasculo‐ductal systems with plastic mass, followed by the corrosion of the renal parenchyma with hydrochloric acid. There have been revealed 66 corrosion casts (88%) with 2 renal arteries and 9 casts with 3 renal arteries (12%). 68% of the corrosion casts presented 5 renal segments; 25.33% presented 6 renal segments; 4% of the casts presented 7 segments, 2.67% presented 8 renal segments. The main renal artery of the kidney is: the superior renal artery in 64% of the cases; the middle renal artery in 5.33% of the cases and the inferior renal artery in 30.67%. The knowledge of these morphological aspects is important for the urologic surgery of resection and transplantation (Supported by UEFISCDI 42097/2008).

Study of Multiple Renal Arteries Using Corrosion Casts and CT Angiography

This study evaluated the vascular territories of multiple renal arteries according to their trajects and distances between their origins.The materials used were 200 renal corrosion casts, made by injecting the vascular and ductal elements with a plastic compound and corroding the parenchyma with hydrochloric acid, and 100 CT angiographies conducted with a Siemens Somatom Sensation 64 CT.There was a 22% frequency of multiple renal arteries. The CT angiographies were used to analyze the distances between the arteries' origin points and their trajects. The distances varied between 0.1–5.7 cm and the trajects of the additional arteries, in comparison to that of the main artery was parallel (above or below) in 42% of cases, ascending in 31% of cases, descending in 19% of cases and crossing in 9% of cases. Arteries only crossed when the distance between their origins was less than 0.8cm (9.53% of cases). The corrosion casts were used to determine intraparencymatous division and vascular territories. The superior renal artery is the main one in 76.2% of cases, the middle one in 2.38% of cases and the inferior one in 16.66% of cases. In 4.76% of cases, there are two main arteries – superior and middle or superior and inferior (equal occurrences).Combining the two methods of study allows a more complex analysis of morphological parameters, the trajects and vascular territories in the cases where multiple renal arteries are present.

Human doubled renal and testicular arteries

Doubled renal and testicular arteries were found in a well-developed 69-year-old caucasian male. The right kidney had two renal arteries, one at its usual midorgan (hilar) position and one inferior polar. One testicular artery arose from the mid-point of the usual renal artery, passed under the renal vein at its junction with the inferior vena cava, and then crossed over the inferior polar renal artery. The second testicular artery arose from the inferior polar renal artery near its origin from the abdominal aorta. The two testicular arteries remained doubled throughout their course and both entered the right testis at separate sites on the organ. The inferior vena cava passed under the inferior polar and over the superior testicular artery and the superior renal artery.