局部血管几何构型与动脉粥样硬化性肾动脉狭窄的关系

目的:研究局部血管几何构型与动脉粥样硬化性肾动脉狭窄(ARAS)的关系.对动脉粥样硬化性疾病患者,经肾动脉磁共振血管成像检查的资料,分别进行三维图像分析,比较狭窄肾动脉与非狭窄肾动脉的局部几何构型参数变化.结果表明:对48例肾动脉磁共振血管成像的检查结果均显示,右肾动脉狭窄的发生率明显高于左侧.通过对肾动脉磁共振血管成像构建的三维图像分析显示,狭窄的左侧肾动脉与矢状面的夹角大于左侧正常的肾动脉与矢状面的夹角,右侧狭窄肾动脉所对应的腹主动脉横径,大于右侧正常肾动脉所对应的腹主动脉横径,在单纯右侧肾动脉狭窄的患者中,其患侧肾动脉与矢状面的夹角,要大于其相应健侧肾动脉与矢状面的夹角.在动脉粥样硬化性肾动脉狭窄的患者中,左、右侧肾动脉的发病率有明显差异.部分局部几何构型参量的改变,可能与动脉粥样硬化性肾动脉狭窄的发生有关.     

Rare origin of supernumerary renal vessels supplying the lower pole of the left kidney

The current observations have documented rare vascular anomalies in the right and left kidneys from a male and female cadaver, respectively. In the female left kidney in addition to being supplied by the normal renal artery and vein it contained a left lower polar renal artery and vein. The polar artery took origin from the inferior mesenteric artery to supply the lower pole and was drained by the left lower polar vein that opened into the left common iliac vein. The right kidney from a male cadaver showed supernumerary renal arteries and veins. The supernumerary upper renal artery took origin from the aorta and after a short course it gave rise into a cranial branch that took a long course to supply the lower pole and a caudal branch that entered the right kidney at the hilum. The supernumerary lower renal artery also took origin from the aorta and passed to supply the lower pole of the right kidney. Therefore, the lower pole of the right kidney received two arteries, but was not associated with a polar vein. The right kidney in addition to the normal right renal vein contained a supernumerary right renal vein. The vein was seen at the hilum and was the most posterior structure; passing behind the supernumerary lower renal artery to open into the posterior surface of the inferior vena cava. The anomalies described in the current observation present a unique pattern of congenital renal vascular abnormalities that may be of surgical importance.     

Renal blood flow in twins

The aim of this preliminary study was the estimation of renal blood flow in 16 premature newborns from twin pregnancies with mean body weight 1270 g and mean gestational age 29 weeks. In control group we have 16 singleton newborns with mean gestational age 29 weeks and mean birth weight 1240 g. In both intervention and control group we have the similar clinical symptoms. The renal blood flow was carried out in the first day of life with the Acuson 128 XP Colour Doppler using the 6 and 7 MHz linear transducer. The renal blood flow parameters-PI, RI, Vmax, Vmin Vmean were measured in right and left renal arteries in theirs courses from the aorta to the renal hilus, by color sinal. In the investigation group the mean value of RI in right and left renal artery was 0.88. Mean PI in right vessel was 1.67 and in left 1.56. Mean V min in right and in left artery was 0.03 and mean V max in right artery was 0.34 and in left 0.33. Mean value of mean velocity in right vessels was 0.18 and in left 0.19. In control group we observed in right artery mean value of PI 1.74 and in left 1.6. Mean RI was 0.86 and 0.86 in right vessel in left vessel. Mean V min was 0.05 in right and 0.04 in left artery. Mean V max was 0.37 in right and 0.34 in left artery. Mean value of V mean was 0.19 in right artery and 0.18 in left artery. Using the student, Mann-Whitney and Shapiro-Wilk tests we have not observed statistically significant difference of Doppler parameters between control and investigation group and between the left and right artery. Although in newborns with broad PDA we noted significant higher value of RI (0.97, 0.98) than in newborns without PDA (0.78, 0.81).     

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.     

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.     

High bifurcation of abdominal aorta upon horseshoe kidney at the level of upper L2 vertebral body: a rare case report

A high-positioned bifurcation of abdominal aorta upon a horseshoe kidney at the level of upper L2 vertebral body was detected during contrast enhanced abdominal computed tomography scan. The isthmus was clamped between the two elevated and extended common iliac arteries. The right renal artery arose from right common iliac artery supplying the superior and medium segments of right kidney. The left renal artery originated from right common iliac artery and branched off into three main arteries supplying the medium segment of right kidney, the inferior segment of right kidney and the lower half part of left kidney, respectively. The left accessory renal artery arose from abdominal aorta supplying the upper half part of left kidney. The inferior mesenteric artery arose from right common iliac artery. Lumbarization anomaly, scoliolosis, asymmetric pelvis and serious hydronephrosis of left kidney were also found. We describe this rare case of variations and discuss the possible embryonic development mechanism.     

浙西南地区中老年人群肾动脉影像解剖学特征

目的　探讨浙西南地区中老年人群的肾动脉影像特征,为临床肾动脉介入手术提供影像解剖学资料。 方法　抽取浙江省丽水市10个城镇社区常住人口中45~75岁者为研究对象,收集问卷资料,行肾动脉CTA检查,采用西门子FORCE CT行腹部CT增强扫描,观察肾动脉的起源、结构,入肾位置及变异等情况,按性别及侧别进行统计分析。 结果 共纳入3090例,男1447例,女1643例,男性和女性在吸烟、饮酒、身高、腰围、舒张压、脉压、服用高血压药物、服用糖尿病药物方面存在显著性差异（P＝0.00）。男性和女性双侧肾动脉的长度和外径无统计学差异（P>0.05）,肾动脉长度和平均外径左侧为（37.43±13.73）、（6.37±6.6）mm,右侧为（24.52±25.5）、（4.4±2.67）mm。肾动脉与腹主动脉夹角均以大于45 °为主,男性左72.3%,右70.9%;女性左74.8%,右71.8%。肾动脉开口位置集中在第2腰椎和第1腰椎（左L2 67.8%,L1 30.1%）;（右L2 75.9%,L1 20.4%）,肾动脉开口位置均为右侧较高（男56.7%,女56.6%）。肾动脉经肾门入肾为主（男48.5%,女47.6%）。肾血管走形左侧以上斜型为主,右侧以平直型为主,两侧有统计学差异（P＝0.00）。肾动脉变异的发生率男性24.5%（95% CI 22.3% ~26.8%）,女性22.3%（95% CI 20.3% ~ 24.4%）。男性副肾动脉检出率为15.4%（95% CI 13.5% ~ 17.3%）,女性为11.1%（95% CI 9.7%~12.7%）。单侧副肾动脉发生率为15.0%,双侧为3.9%。 结论 运用CT可直观、准确地显示肾动脉结构及其变异情况,男性和女性肾动脉的变异差异较大,术前行肾CTA检查可明确肾动脉结构和变异,有利于肾动脉介入术的顺利开展。     

Unusual origin of the right renal artery: a case report

An anomalous origin of the right renal artery was observed in a 50-year-old male cadaver. The importance of this variation of the right renal artery and superior mesenteric artery arising from a common trunk is emphasised.     

Comparative anatomical study of the kidney position in amniotes using the origin of the renal artery as a landmark

The anatomical relationship between the kidney position and its arterial supply was investigated in 21 mammals, 1 bird, and 3 reptiles (n = 1 for each species) and in 43 human cadavers. The following observations were made. (1) Although the right kidney was located caudal to the left kidney in 29 out of 43 human cadavers (67.4%), the origin of the right renal artery from the aorta was located cranial to the origin of the left renal artery in 36 human cadavers (83.7%). Therefore, the relative positions of the kidneys do not correspond with the relative origins of the renal arteries in humans. (2) Among the mammals that were examined, the position of the kidney and the branching level of the renal artery on the right side were usually cranial to those on the left side. (3) In the bird and most reptiles that were examined, kidneys were typically located in the pelvic region and were supplied by segmental arterial branches. These results suggest that the right kidney and its arterial supply are generally located cranial to the left kidney in phylogeny of mammals. While the presence of a human accessory renal artery in 9 out of 86 sides (10.5%) and a cranial origin of the left renal artery relative to the right renal artery in 7 out of 43 cadavers (16.3%), shows some variation in the arterial supply to the kidneys, the origin of the renal arteries can generally be used as phylogenetic landmarks indicating the relative positions of the kidneys. Hence, from an ontological perspective, the human right kidney may be initially situated cranial to the left kidney during the early stages of development. Thereafter, the human right kidney may shift downwards secondary.     

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

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.     

Pelvic kidney with an unusual blood supply angiographic findings

A right pelvic kidney was observed in a patient, who presented with hypertension. On angiograms, the left kidney was normally positioned and had a single renal artery, whereas the right pelvic kidney received three arteries, which arose from bilateral common iliac arteries and from ipsilateral internal iliac artery. The renal arteries from the ipsilateral internal iliac artery and the contralateral common iliac artery supplied the medial half of the pelvic kidney. In the present case, the blood supply from both the right and left sides appeared to be related to the medial position of the right pelvic kidney. As the incidence of unilateral renal ectopia is not extremely low, it is possible to encounter in a surgical or cancer treatment case. Variations in the positional anatomy of the kidney and its vascular supply are of clinical importance and our case illustrates a different kind of blood supply that a pelvic kidney may possess.     

TWO AUTOPSY CASES OF RENAL HYPERTENSION WITH HYDRONEPHROTIC PYELONEPHRITIS DUE TO FIBROUS RETROPERITONITIS

Two autopsy cases of renal hypertension with hydronephrotic pyelonephritis due to fibrous retroperitonitis are reported.
The first case suffered from continuous hypertension, inspite of nephrectomy of the left kidney which was conspicuously atrophic and showed marked hydroureter due to proliferative endoarteritis of the left renal artery and retroperitoneal fibrosis. On autopsy, there was compensatory hypertrophy of the right kidney with partial cicatrical contraction due to obstructive endoarteritis of the lower branch of the right renal artery. The retroperitoneal fibrosis extended from the pericystic area to the upper abdomen.
The second case had two remarkable changes, one of which was atrophy of the right kidney due to proliferative endoarteritis of the stem of the right renal artery and another was bilateral hydronephrotic pyelonephritis owing to retroperitoneal fibrosis.
Moreover, systemic proliferative vasculitis were found in both cases.
The relationship of these lesions was discussed.     

Diagnostic and treatment of renovascular hypertension in the patient with horseshoe kidney

A patient with renovascular hypertension and horseshoe kidney is presented. Diagnostic work-up consisted of ultrasonography, color-Doppler of renal arteries, dynamic scintigraphy with captopril test, separate renin, intravenous urography and computed tomography. Renal angiography revealed several aberrant renal arteries with significant fibromuscular dysplasia of the proximal artery of the right kidney. Contrast magnetic resonance of the kidneys with gadolinium was also performed. Following diagnostic procedure, a 5 mm balloon dilatation of the right proximal renal artery was performed. Immediate renal angiography showed no stenosis of the right proximal artery. The patient's blood pressure normalized after the invasive procedure. The diagnosis and treatment in the patient with renovascular hypertension due to fibromuscular dysplasia and horseshoe kidney are described. As renovascular hypertension is a rare diagnosis, this case report may help physicans recognize patients with this type of arterial hypertension.     

Altered course of the right testicular artery

An unusual course of the right testicular artery was observed during routine dissection of the posterior abdominal wall of a 60-year-old male cadaver. It arose from the abdominal aorta, inferior and posterior to the origin of the right renal artery, and passed posterior to the inferior vena cava and right renal vein; it then arched anterior to the inferior pole of the right kidney and descended anterior to the psoas major muscle, crossing anterior to the genitofemoral nerve, ureter and the proximal part of the external iliac artery. Finally, it passed to the deep inguinal ring and through the inguinal canal to enter the spermatic cord with the other constituents. The left testicular artery arose from the abdominal aorta about 1 cm higher than the right testicular artery and followed a normal course. The embryologic basis and clinical importance of this case are discussed.     

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.     

Rare case of right accessory renal artery originating as a common trunk with the inferior mesenteric artery: a case report

Dissection of a male cadaver revealed several vascular abnormalities in the abdominal cavity, notably of the renal circulation. In particular, three renal arteries were observed on the right side and two on the left. On the right side, one accessory renal artery originated as a common trunk with the inferior mesenteric artery. Additional variations included a left inferior phrenic artery originating from the celiac trunk, bilateral testicular veins emptying into renal veins, and the left testicular artery arising from the left renal artery. The possible embryonic development of these branching patterns and their clinical significance are discussed briefly.     

Duplicate testicular veins accompanied by anomalies of the testicular arteries.

Duplicate testicular veins associated with other anomalies of the testicular arteries were observed during dissection of the posterior abdominal wall in a 90-year-old Japanese male cadaver. The right testicular vein was composed of the medial and lateral testicular veins. The medial testicular vein drained into the inferior vena cava, whereas the lateral testicular vein drained into the confluence of the inferior vena cava and right renal vein. Several anastomosing branches were seen between the medial and lateral testicular veins. The left testicular vein was formed after the medial and lateral venous trunks joined and drained into the ipsilateral renal vein. The right testicular artery originated from the anterior surface of the abdominal aorta at the level of the left renal artery, passed posterior to the inferior vena cava, and accompanied the right lateral testicular vein running downwards. The left testicular artery arose from the abdominal aorta at a level of 5 cm below the origin of the right testicular artery, and then ran downwards accompanied by the medial trunk of the left testicular vein.     

A rare variation of the right middle suprarenal artery

According to general knowledge, the suprarenal gland is supplied by three sources: the phrenic artery, the abdominal aorta and the renal artery. Since the gland lacks a hilus, and particularly because of its clinical importance, anatomical arterial sources and branching is still not uniform and it needs to be determined by detail. In this study, the right middle suprarenal artery arising from the right renal artery was observed on the right side of a 45-year-old male cadaver.     

Complex renal vascular variation: a case report.

As the number of renal surgical interventions increase a better understanding of the anatomy of renal arteries and their branches gain in importance. Here we describe a common trunk from the right side of the aorta ramifying into suprarenal and two renal hilar arteries in a 40-year-old male cadaver detected during dissections performed in a routine gross anatomy course. The suprarenal branch is divided into several smaller branches to supply blood to the suprarenal gland. The superior renal hilar artery gave rise to the right testicular artery and an additional suprarenal artery. The inferior renal hilar artery gave rise to one more additional suprarenal artery. The superior renal hilar artery crossed the inferior renal hilar artery. On the same side renal veins were also doubled. For better outcome interesting variations such as in this case should be kept in mind before and during any interventions involving this region.