Anatomical study of triple renal arteries

Within an 8 year study of the renal blood supply, the authors assessed 14 cases of triple renal arteries, 2 of them bilaterally (both on human fetuses), so a total of 16 triple renal arteries. Among the 14 cases of unilateral triple renal arteries, 8 were placed on the left side. In what concerns the caliber, the renal artery that enters the kidney through the hilum is usually greater than the others; in only three fetal samples the triple renal arteries were almost equal in caliber. Concerning the arterial traject, in 5 of the cases, two of the three renal arteries crossed one another; this aspect was assessed in first two arteries (2 cases) and last two arteries (3 cases). In 3 cases, the triple renal arteries were accompanied by double renal arteries on the opposite side. The almost parallel traject of the triple renal arteries was assessed in only 3 cases.     

Morphological assessments on the arteries of the superior renal segment

The study was performed on 461 renal arteries in order to assess some morphological aspects regarding the arteries that supply the superior renal segment using as study methods: dissection, injection of contrast medium, injection of plastic followed by corrosion together with the examination of MRI and renal angiographies (simple and angio CT). The posterior arteries of the superior renal segment originate mostly from the posterior terminal branch of the renal artery as 1–3 arterial branches. In only 42 cases, we found posterior branches that do not participate in the supply of the superior renal pole. In 190 cases, the anterior arteries of the superior segment originated from the anterior division of the renal artery and in 73 cases directly from the trunk of the renal artery. 34 cases were assessed as a terminal division of the renal artery, while the origin from the posterior division of the renal artery was encountered in 18 cases. In 138 cases, the artery of the superior segment originated from a supplementary renal artery, double (118 cases) or triple (20 cases); in this situation, from the polar artery started the inferior suprarenal artery, except five cases where it originated from the aorta. Of the total of 461 samples, in 244 cases the renal approach was performed above the renal hilum, as proper superior polar arteries and in 217 cases the artery entered through the upper part of the hilum as an apical artery. The morphology of the arteries of the superior renal segment shows a significant degree of variability mostly in what concerns the anterior ones. Frequently we encountered a clear delimitation of the superior renal segment (in 61% of the cases), a situation that allows a relatively facile nephrectomy.     

Bipolar supernumerary renal artery

The variations of renal arteries are considered critical issues that surgeons should have thorough envision and appreciation of the condition. Variations of these vessels may influences urological, renal transplantation and laparoscopic surgeries. We present a case of bilateral accessory renal artery with a striking pre-hilar branching pattern encountered upon digital subtraction angiography (DSA) for imaging of the renal arteries of a healthy 30-year-old man, renal transplant donor. The right kidney received two renal arteries from the aorta including a main hilar and one lower polar. However, the left accessory artery while originated from the aorta, simultaneously, supplied both upper and lower renal poles following its pre-hilar division that replaced upper/apical and lower segmental arteries of the single main renal artery, respectively. The left main renal artery divided into two anterior and posterior segmental arteries. Whether this should be categorized either as an accessory hilar artery or a unique variant of renal arterial supply, the so-called bipolar supernumerary renal artery, is a matter of debate. We discuss possible embryologic origin and clinical aspects of accessory renal artery.     

Double renal arteries originating from the aorta

From a study of renal vascularization, we present 54 cases of double renal arteries supplying one kidney and originating from the aorta. Of the 54 cases, 42 were unilateral, showing a left predominance (25 cases), three of them with triple renal arteries on the opposite side. In six cases we encountered bilateral double renal arteries. Most often, the supplementary renal artery originated from the lateral side of the aorta (58%). Examination of the renal approach showed that in 28 cases the supplementary renal artery entered the kidney through the hilum (proper supplementary renal artery), in 16 cases it was inferior polar, in five cases it was superior polar and in five cases the supplementary renal artery terminated in two branches, equal in caliber, one polar and the other hilar, thus showing a combined character, identical with the manner of termination of the main renal artery. In most of the samples the supplementary renal artery ended with a bifurcation inside the kidney, either into the renal sinus (proper supplementary renal artery) or inside the renal parenchyma (polar supplementary renal artery). The course of the double renal arteries showed multiple variations: retro-ureteral passage of the supplementary renal artery (6 cases), right supplementary renal artery passing anterior to the inferior vena cava (5 cases), crossed course of the double renal arteries (5 cases). Double renal arteries may coexist with other uro-vascular variations, such as: double renal veins on the same side (4 cases) or on the opposite side (3 cases), double ureter on the same side (2 cases) or on the opposite side (1 case), persistence of the fetal renal lobulation on the adult kidney (3 cases) and genital artery originating from the supplementary renal artery (3 cases).     

Anatomy of renal arterial supply

A thorough knowledge of the variations of the renal artery has grown in importance with the increasing numbers of renal transplants, vascular reconstructions, and various surgical and radiologic techniques. The literature indicates that multiple renal arteries are found in 9- 76% of cadavers. The purpose of this study is to establish the incidence and characteristics of variations of renal arteries in Thais. A total of 267 Thai cadavers were dissected in the anatomy laboratory. The anatomical findings included: a single hilar artery in 82% of cases; double renal arteries in 17% of cases (one hilar artery with an upper polar artery occurred in 7%; two hilar arteries in 7%, and one hilar artery combined with one lower polar artery in 3%); and triple renal arteries occurred in 1% (two hilar arteries with one upper polar artery in 0.4% and two hilar arteries with one lower polar artery in 0.6%). In preparation for interventions, such as living renal donation, vascular reconstruction, renovascular hypertension, or radical nephrectomy, the results indicate that preoperative renal imaging is necessary and that operative techniques with attention to multiple renal arteries should be considered.     

移植肾血管变异的临床处理

背景：血管吻合技术的好坏直接关系到肾移植的成败。 目的：提高肾移植变异血管吻合的技术方法。 方法：1999年9月至2010年12月广东省第二人民医院器官移植科共完成878例肾移植,对其中供肾存在的动静脉血管变异进行修整、合并、延长等重建处理后进行移植,副肾动脉采用改良支架支撑法同腹壁下动脉吻合。 结果与结论：878例肾移植中,55例供肾动脉变异,肾静脉变异22例,经血管修整重建后均成功与受者髂内或髂外血管吻合。23例直径大于1 mm副肾动脉与腹壁下动脉吻合均取得成功。移植后彩超显示肾动静脉吻合口血流及副肾动脉血流正常。提示移植肾血管变异及副肾动脉只要正确处理,吻合得当,可以安全有效地移植给受者并获良好效果。     

Effects of selective phosphodiesterase inhibitors on isolated coronary, lung and renal arteries from man and rat.

The relaxant effects of some isozyme-selective phosphodiesterase inhibitors were evaluated in isolated human and rat coronary, lung and renal arteries. Milrinone and OPC 3911, inhibitors of a cGMP-inhibited cAMP phosphodiesterase (cGI-PDE), were shown to have distinct vasodilator actions. These agents were less potent as relaxants in rat lung and renal arteries than in the corresponding human tissues. OPC 3911, the more potent cGMP-inhibited cAMP phosphodiesterase inhibitor, was found to be the more potent vasorelaxant. Rolipram, a selective inhibitor of a cGMP-noninhibited cAMP phosphodiesterase, had small effects on coronary and lung arteries, but produced a slightly more pronounced relaxation of renal arteries from both man and rat. In human preparations contracted by 30 mM K+, milrinone and OPC 3911 had similar relaxant profiles, and were as potent in coronary as in renal arteries. These results do not support the notion that milrinone has reduced effects on renal vessels in man and show that there may be species differences in vascular responsiveness to cGMP-inhibited cAMP phosphodiesterase inhibitors.     

Unusual origin and course of the testicular arteries

Background The testicular arteries usually arise from the anterolateral aspect of the abdominal aorta just inferior to the renal arteries at the level of the second lumbar vertebra. However, they may also originate from the renal artery, middle suprarenal artery, one of the lumbar arteries, common or internal iliac artery, or the superior epigastric artery. Methods An unusual origin of the right testicular artery and an unusual course of the left one were observed during routine dissection of the retroperitoneal space of a 43-year-old male cadaver. Results The right testicular artery originated from the inferior segmental branch of the right renal artery. After the left testicular artery originated from the anterolateral surface of the abdominal aorta just inferior to the left renal artery it was located between the left renal vein and the left renal artery and descended anterior to the renal vein. Thereafter it coursed on its normal route distally with the testicular vein. Conclusions Awareness of variations of the testicular arteries, such as that shown in this case, is important during surgical and radiological procedures pertaining to kidney.     

Effects of selective phosphodiesterase inhibitors on isolated coronary,lung and renal arteries from man and rat

The relaxant effects of some isozyme-selective phosphodiesterase inhibitors were evaluated in isolated human and rat coronary, lung and renal arteries. Milrinone and OPC 3911, inhibitors of a cGMP-inhibited cAMP phosphodiesterase (cGI-PDE), were shown to have distinct vasodilator actions. These agents were less potent as relaxants in rat lung and renal arteries than in the corresponding human tissues. OPC 3911, the more potent cGMP-inhibited cAMP phosphodiesterase inhibitor, was found to be the more potent vasorelaxant. Rolipram, a selective inhibitor of a cGMP-noninhibited cAMP phosphodiesterase, had small effects on coronary and lung arteries, but produced a slightly more pronounced relaxation of renal arteries from both man and rat. In human preparations contracted by 30 mm K⁺, milrinone and OPC 3911 had similar relaxant profiles, and were as potent in coronary as in renal arteries. These results do not support the notion that milrinone has reduced effects on renal vessels in man and show that there may be species differences in vascular responsiveness to cGMP-inhibited cAMP phosphodiesterase inhibitors.     

Anatomic variations of the renal vessels: focus on the precaval right renal artery

The aim of this study was to determine the prevalence of precaval right renal artery and to investigate the distribution of renal arteries and veins. We discuss a theory of development of renal vascular variants. We retrospectively reviewed 120 arterial phase contrast material-enhanced spiral computerized tomography scans of the abdomen (1- to 2-mm section thickness) performed during a two-month period. Forty percent of the study group (48 patients) had one artery and one vein on each side, with typical course. There was a 9.17% prevalence of precaval right renal artery: 10 patients had a lower pole accessory artery in precaval position and one patient had the main and the accessory arteries that pass anterior to the inferior vena cava. In these cases, associated variations of renal vessels were higher than in the patients without precaval artery variant. There were multiple arteries in 28.3% of the right kidneys and in 26.7% of the left ones. Variants of the right renal vein consisted in multiple veins in 20% (24 cases). We detected no case of multiple left renal veins, but we described variations of its course (circum- or retroaortic vein) in 9.17% (11 cases). Twenty-six patients (21.7%) had associated variations of the renal pedicle. The current technical support allows for a minimally invasive study of vessels anatomy. In our study the prevalence of a precaval right renal artery appears to be higher than previously reported (9.17%). Knowledge on anatomical variations of right renal artery and associated renal vessels variations has major clinical implications.     

Multiple variations of the renal and testicular vessels: possible embryological basis and clinical importance

During routine dissection of the abdominal cavity of a 55-year-old African male cadaver, multiple anomalies including renal and testicular vessels were encountered. The right kidney was supplied by three right hilar renal arteries arising from the abdominal aorta at different vertebral levels whereas only one left renal artery supplied the left kidney. On the right three renal veins drained the kidney into the inferior vena cava. In contrast, the left kidney was drained by a single renal vein which received a large primary posterior tributary. The primary posterior tributary had three tributaries from the posterior lumbar region. The right testis had two sources of arterial supply; one from the subcostal artery and another from the abdominal aorta. The left testis was supplied normally by a single testicular artery. The right testis was drained by four testicular veins as follows: one drained into the subcostal vein, the other two drained separately for a longer course and joined shortly before draining into the right main renal vein, the fourth one drained into the anterior aspect of the inferior vena cava at the level of the second lumbar vertebra. On the left, the testicle was drained by two testicular veins which travelled separately from the deep inguinal ring and joined shortly before they drain into the left renal vein. This variation may represent an immature form of complicated development of kidneys and testes. Additionally, emphasis must be put on preoperative vascular examination to avoid surgical complications from variant vessels in this region.     

Bilateral accessory renal arteries associated with some anomalies of the ovarian arteries: A case study

Accessory renal arteries are found frequently—more often on the left side and occurring in as high as 30–35% of cases in some series. These arteries usually enter the upper or lower poles of the kidney. The main clinical significance of such arteries entering the lower pole is that they may obstruct the ureter and lead to hydronephrosis. We report the presence of accessory renal arteries found during routine dissection in an elderly female cadaver. The uniqueness in the variations noted in our cadaver included (1) a dual relationship of the ureters to the accessory renal arteries and (2) both the right and left ovarian arteries originating from their respective accessory arteries. Anomalous renal vessels arise as a result of the complicated development of the kidneys. Similarly, the aberrant origins of both the ovarian arteries observed here could be explained on an embryological basis. Clin. Anat. 11:417–420, 1998. © 1998 Wiley-Liss, Inc.     

The structural reorganization of the arteries of the brain and kidneys in experimental aortic coarctation

Structural changes of cerebral and renal arteries were studied in 25 dogs with hemodynamic model of aorta coarctation and 10 control animals using histological, histochemical and morphometric methods. It was established in aorta coarctation due to growth and decrease of blood supply into cerebral and renal basins a series++ of compensatory adaptive, adaptive and pathological changes develop in vessels. The first are manifested in cerebral arteries through hypertrophic and hyperplastic changes of media smooth myocyte circular musculature, the second in renal arteries they are manifested through these musculature atrophy. The second--through the development of oblique-longitudinal musculature; the latter--through the reduction of these vessels lumen and the developments of angiosclerosis and angiohyalinosis.     

Anatomical variations of the renal arteries and renal transplantation

This study reports a retrospective analysis of the details of the anatomy of the renal arteries of 403 kidney donors and the arterial complications related to 513 subsequent kidney transplants in our transplant unit. Multiple renal arteries occurred bilaterally in 10.2% of donors and unilaterally in 20.8%, a total incidence of 31%. There was a higher incidence of vascular-related complications following transplantation of kidneys with multiple renal arteries. Attention is drawn to the need for careful technique in identification of multiple renal vessels, especially aberrant vessels, at the time of donor nephrectomy and also to the different techniques available for anastomosis of multiple renal arteries in kidney transplant recipients. © 1992 Wiley-Liss, Inc.     

Multiple renal vessels associated with testicular vessels

A rare case of multiple renal vessels associated with testicular vessels was found from 85-year-old male cadaver undergoing routine dissection. The characteristic findings in the cadaver included the presence of five right renal arteries and three left renal arteries arising from the abdominal aorta, and the right testicular artery originated from the right middle hilar artery and the left testicular artery originated from the left inferior hilar artery. This variation may represent an immature form of complicated development of the kidneys and testes.     

Origins of the gonadal artery: embryologic implications

The gonadal arteries are paired vessels that usually originate from the abdominal aorta at the level of second lumbar vertebra. In 5-20% of cases, the gonadal artery has a high origin (superior to L2) and in 5-6% of cases it originates from the main or accessory renal artery. The latter is referred to here as an aberrant gonadal artery. Ninety-eight kidneys of 50 healthy potential renal transplant donors were prospectively studied by conventional angiography. The renal artery, either main or accessory, was detected and individually injected to highlight their perihilar divisions and possible extrarenal branches. The gonadal arteries were recorded if they originated from the renal arteries. We found that 39% (n = 38) of kidneys had at least one accessory renal artery. In 14 sides (14% of kidneys), the gonadal artery (11 right and 3 left) originated from the renal artery, either main (n = 5) or accessory (n = 9). Ten out of 14 kidneys with an aberrant gonadal artery had an associated accessory renal artery. In nine cases, the gonadal artery originated from the accessory renal artery, and in one case, although it originated from the main renal artery, the same kidney had an accessory arterial supply. The results of this study demonstrate that aberrant gonadal arteries tend to originate from kidneys that possess an accessory arterial supply. We hypothesize that aberrancies of the gonadal artery are a part of a common embryologic error resulting in the persistence of the future accessory renal arteries. We believe that this study is the first to hypothesize and study such an association with these arterial anomalies of the renal pedicle.     

Bilateral high origins of testicular arteries: a rare variant

We report a very rare case of bilateral high origins of testicular arteries in a 66-year-old Chinese male cadaver. The arteries originated from the antero-lateral aspect of the abdominal aorta, cranially to the origins of ipsilateral renal arteries. Approximately 1.1 cm after its origin, the right testicular artery gave off the middle suprarenal artery. During its course, the artery crossed anterior to the right renal vessels. The left testicular artery coursed posterior to the left suprarenal vein, anterior to the left renal vessels. Variants of the origin and course of the testicular artery are important during renal and testicular surgeries.     

Studies on the vasa vasorum of the human renal artery.

The transplantation of a donor kidney is currently the treatment of choice for terminal renal insufficiency. However, major postoperative problems may be caused by vascular complications. It was therefore decided to look for possible correlations between these vascular problems and the arterial wall supply. The following methods were used to elucidate the origin and distribution of nutrient vessels: 1. Injection of the abdominal aorta with resin in three fresh cadavers. 2. The precise microscopic location of the branches originating from the renal arteries in eighteen autopsy subjects. 3. Abdominal angiography and selective angiography of the first left lumbar artery and left renal artery in one patient. It was found that the renal artery receives its blood supply from both internal and external nutrient vessels. The external vascular supply of the renal arterial wall originates from the aorta itself, from the inferior suprarenal artery (which sometimes has connections with the first and/or second lumbar artery) or from the diffuse vascular system of the retroperitoneal space. Because of the variety in number, course and origin of these nutritional vessels, an ideal point for the anastomosis of the renal artery cannot be indicated.     

The Cellular Pathology of Experimental Hypertension: VI. Alterations in Retinal Vasculature

The ultrastructure of retinal arterial vessels from rats with severe renal hypertension has been studied. The permeability of retinal vessels has also been examined by means of vascular labeling technics utilizing horseradish peroxidase and microperoxidase as tracer substances. Small retinal arteries and arterioles exhibit foci of smooth muscle necrosis characterized initially by fragmentation of medial smooth muscle cells, and subsequently by loss of myofilaments and release of free vesicles, vacuoles and other cytoplasmic organelles extracellularly. Evidence for increased permeability is observed occasionally in retinal capillaries and less frequently in arteries and arterioles. The enzymatic tracers penetrate the tight junctions of the endothelial cells and are found in the basement membranes adjacent to endothelial and smooth muscle cells, as well as in expanded extracellular spaces around the capillaries. The alterations in the ultrastructure and permeability of retinal vessels in experimental hypertension have been compared with that of visceral and cerebral cortical vessels.