Multiple variations in the paired arteries of the abdominal aorta

Variations in the origin of arteries in the abdomen are very common. The arteries that show frequent variations include the celiac trunk, renal arteries, and gonadal arteries. We observed multiple variations in a 45-year-old male cadaver. The variations found on the left side were: one accessory renal artery, two testicular arteries, and middle suprarenal and inferior phrenic arteries that branched from the celiac trunk. On the right side, the inferior phrenic and middle suprarenal arteries arose from the right renal artery.     

The morphology and the surgical importance of the gonadal arteries originating from the renal artery

Using dissection and plastic injection followed by corrosion as study methods, we describe 16 cases of gonadal arteries originating from the renal artery. Among them, in 12 cases (75%), we assessed this variation on a single gonadal artery while two gonadal arteries appeared in four cases (25%). In 13 cases (81.25%) the gonadal arteries were located on the left side and in only three cases (18.75%) they were on the right. In seven cases (43.75%), an unique gonadal artery that originated from a single renal artery, in three cases (18.75%) the gonadal artery started from the artery of the inferior segment that started from the anterior branch of the renal artery, in other three cases (18.75%), from the trunk of the renal artery, prior to its terminal ramification and in one case (6.25%), from the artery of the superior segment that started from the anterior branch of the renal artery. In five cases (31.25%), a single gonadal artery started from a supplementary renal artery, in four cases (25%), from double renal arteries (three from the inferior and one from the superior one) and in a single case, from triple renal arteries (from the inferior one). All the four cases (25%) of double gonadal arteries were located on the left. Within them, in two cases, the two gonadal arteries started from the renal artery (unique or supplementary) and in the other two cases, the lateral gonadal artery originated from the renal artery (unique or supplementary) and the medial one from the aorta. This vascular variation shows a significant importance for renal surgery, in partial or total nephrectomy or in the renal transplant as long as it may lead to the compromise of the gonadal blood supply, mostly when the gonadal artery with renal origin is unique, without a second one with aortic or other arterial origin. A gonadal artery with origin from an inferior polar renal artery may be injured during the percutaneous treatment of the syndrome of pielo-ureteral junction, so it becomes a major contraindication. Also, this anatomical variation enhances the importance of the arteriography or Doppler ultrasound examination of the renal hylum. Sometimes, the gonadal artery may pass posterior to the proximal ureter that can be disturbed in traject, leading to hydronephrosis.     

Anatomical variations of the human suprarenal arteries

This is on anatomical study of the suprarenal arteries and their variations in 30 cadavers aimed at providing in a subsequent article the anatomical basis of arterial segments of the gland. The suprarenal glands were supplied by 3 main groups of suprarenal arteries: superior, middle and inferior. Only the superior and the inferior groups were present in all cases, since the middle vessels appeared in only 93.3% +/- 4.6 of the cases. The superior group included on each side 4 arteries in males and 5 in females; the middle group presented only 1 artery on each side in both males and females, and the inferior group exhibited on each side 2 arteries in males and 1 artery in females. The most variable group was the middle one, the aortic origin being the most frequent but with a relatively low incidence (53.3% +/- 9.1 on the right and 46.7% +/- 9.1 on the left). The superior group originated from the posterior branch of the ipsilateral inferior phrenic artery in 83.3% +/- 6.8 on the right and 80% +/- 7.3 on the left. The arteries of the inferior group were branches of the ipsilateral renal artery in 70% +/- 8.4 on the right and 50% +/- 9.1 on the left. The origin of the middle suprarenal arteries from the trunk of the inferior phrenic artery on both sides (26.7% +/- 8.1 on the right and 36.7% +/- 8.8 on the left) should be considered relevant. The anatomical findings warrant a further investigation for the identification, illustration and nomenclature of arterial anatomicosurgical segments.     

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.     

Rare case of the trunk of the inferior phrenic arteries originating from a common stem with a superior additional left renal artery from the abdominal aorta

We describe in this article a rare case of a 39‐year‐old male with an inferior phrenic arteries trunk (IPAaT) originating from a common stem with a superior additional left renal artery (SAdLRA) from the abdominal aorta as revealed by routine multidetector computed tomography angiography. The IPAaT with an endoluminal diameter at the origin of 2.8 mm had an upward path with a total length of 18.4 mm, forking to the right inferior phrenic artery and left inferior phrenic artery. These two arteries had an endoluminal diameter at the origin of 1.7 mm and 2.0 mm, respectively. The presence of the common stem of the IPAaT with a SAdLRA and the length of the IPAaT complicate selective chemoembolization of the liver parenchyma. Clin. Anat. 25:979–982, 2012. © 2012 Wiley Periodicals, Inc.     

The inferior supernumerary renal arteries: A classification into three types

Among cases that had multiple renal arteries on one side, an inferior supernumerary renal artery was found in 24/270 cases (ca. 9%) on the right and in 19/270 cases (ca. 7%) on the left, together with the usual renal artery. We have noticed that there are correlations between their levels of origin from the aorta and their positional relation to the ureter and the inferior vena cava (IVC). An inferior supernumerary renal artery (InfRA) of lower origin passes in front of the IVC and behind the ureter. An InfRA of middle origin passes in front of both the IVC and the ureter. An InfRA of upper origin passes behind the IVC and in front of the ureter or renal pelvis. In addition there was a tendency for the lower origin type to have an ureteric branch, while the middle and upper origin types had a gonadal branch. These findings suggest that different derivations lead to the inferior supernumerary renal arteries.     

Morphological study of a horseshoe kidney with special reference to the vascular system

This is a morphological study on an autopsy case of horseshoe kidney found in a 79-year-old-female cadaver. This kidney consisted of two distinct renal masses that were connected at their lower poles by a parenchymal isthmus that was located in the front of the abdominal aorta at the level of the fourth lumbar vertebra. The kidney was supplied by four arteries arising from the abdominal aorta. The distribution of intrarenal arteries showed that the nature of segmental arteries in the present case was basically the same as in the normal kidney, except that the isthmus had its own blood supply from the artery directly arising from the aorta approximately 28 mm below the origin of the inferior mesenteric artery. Venous drainage from the kidney, including the isthmus, was taken by three veins that opened independently into the inferior vena cava. No congenital malformations were found in other organs. We discuss the anatomical and embryological significance of this anomaly and its associated vascular system.     

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.     

Variations in the source of origin of inferior phrenic artery: a cadaveric study

Introduction: The right and left inferior phrenic arteries perfuse the diaphragm. They may originate either from the aorta, celiac trunk, or from the renal artery. Most textbooks of human anatomy give little information regarding the functional anatomy of the inferior phrenic artery. In the past few years, however, more articles have been published regarding the arterial supply in cases of hepatocellular carcinoma. The inferior phrenic artery is seen as an important source of collateral arterial supply to hepatocellular carcinoma, the hepatic artery being the main source. Materials and methods: A cadaveric study was conducted in the Anatomy Department of Bangalore Medical College during the years 2009–2011. Manual dissection was done to identify the inferior phrenic arteries, and their origins were traced. Results: The inferior phrenic artery arose from the aorta in 53.125%, celiac trunk in 28.125%, renal artery in 15.625%, and the superior mesenteric artery in 3.125% of the 32 cadavers studied. The right inferior phrenic artery arose from aorta in 56.25%, celiac trunk in 18.75%, renal artery in 18.75%, and superior mesenteric artery in 6.25% cases. The left inferior phrenic artery arose from aorta in 50%, from celiac trunk in 37.5%, and the rest arose (12.5%) from the renal artery. Discussion: The results were compared with those of earlier studies so that such findings could be applied in the treatment of hepatocellular carcinoma. The significance of this information is due to the fact that an unresectable hepatocellular carcinoma can be treated by transcatheter embolization of the right inferior phrenic artery, in case it is involved.     

The gross anatomy of the renal sympathetic nerves revisited

Catheter‐based renal denervation techniques focus on reducing blood pressure in resistant hypertension. This procedure requires exact knowledge of the anatomical interrelation between the renal arteries and the targeted renal nervous plexus. The aim of this work was to build on classical anatomical studies and describe the gross anatomy and anatomical relationships of the renal arteries and nerve supply to the kidneys in a sample of human cadavers. Twelve human cadavers (six males and six females), age range 73 to 94 years, were dissected. The nervous fibers and renal arteries were dissected using a surgical microscope. The renal plexus along the hilar renal artery comprised a fiber‐ganglionic ring surrounding the proximal third of the renal artery, a neural network along the middle and distal thirds, and smaller accessory ganglia along the course of the nerve fibers. The fibers of the neural network were mainly located on the superior (95.83%) and inferior (91.66%) surfaces of the renal artery and they were sparsely interconnected by diagonal fibers. Polar arteries were present in 33.33% of cases and the renal nerve pattern for these was similar to that of the hilar arteries. Effective renal denervation needs to target the superior and inferior surfaces of the hilar and polar arteries, where the fibers of the neural network are present. Clin. Anat. 29:660–664, 2016. © 2016 Wiley Periodicals, Inc.     

A macroscopical study of the inferior phrenic artery of female rats, with reference to the embryological background of occurrence of the genital artery from this artery.

The principal aim of this study was to elucidate the general features of the inferior phrenic artery (IPA) of female rats which retain the original embryonic configuration of this artery. The artery of the right side was found to be detached from the renal artery, while that of the left side arose from the aorta. Between these fellow arteries, however, no essential morphological differences were discernible. At some point not far from their origin, they were found to break up into the ascending, suprarenal, suprareno genital and descending arteries. The ascending artery of the right side coursed along with the phrenic nerve, and vascularized a greatest portion of the total area of the partes sternalis et costalis of the diaphragm. Furthermore, the artery was found to be intimately associated with the inferior caval vein. Thus, it could be assumed that this artery of adult rats has been embryologically related to the musculus diaphragmaticus, transverse septum, ventral pleuroperitoneal fold, and the caval venous mesentery. The suprarenal artery took its course along the superior margin of this gland to reach the lateroinferior part of the pars costalis of the diaphragm. Its course and destination strongly indicates that in its development the suprarenal artery has been intimately related to the formation of the ventral pleuroperitoneal fold. The suprarenogenital artery was characterized as giving off a genital branch which entered first the diaphragmogenital ligament, and then took a descending course toward the ovary, in a quite similar manner of origin and course to those of the aberrant gonadal (testicular and gonadal) arteries observed in Japanese human adults (Shinohara et al., 1990; Hanie, to be published). The descending artery was observed to be closely associated with the major splanchnic nerve and the celiac ganglion. The variability of arteries of the IPA of female rats and also of humans, seems to reflect dramatic changes which have occurred in the early stages of development, and have influenced more or less the morphology of the uppermost abdominal anlages of the followings: transverse septum, musculus diaphragmaticus, dorsal and ventral pleuroperitoneal folds, suprarenal gland and celiac ganglion, urogenital organs, inferior caval vein in the caval venous mesentery. In conclusion, it could be said that the anatomy of female rats provide us valuable clues as to the essential configuration of the IPA of humans and the relationships of the IPA to structures which are thought to be directly involved in the development of this artery.     

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。     

Angioarchitecture of the coeliac sympathetic ganglion complex in the common tree shrew (Tupaia glis)

The angioarchitecture of the coeliac sympathetic ganglion complex (CGC) of the common tree shrew ( Tupaia glis ) was studied by the vascular corrosion cast technique in conjunction with scanning electron microscopy. The CGC of the tree shrew was found to be a highly vascularised organ. It normally received arterial blood supply from branches of the inferior phrenic, superior suprarenal and inferior suprarenal arteries and of the abdominal aorta. In some animals, its blood supply was also derived from branches of the middle suprarenal arteries, coeliac artery, superior mesenteric artery and lumbar arteries. These arteries penetrated the ganglion at variable points and in slightly different patterns. They gave off peripheral branches to form a subcapsular capillary plexus while their main trunks traversed deeply into the inner part before branching into the densely packed intraganglionic capillary networks. The capillaries merged to form venules before draining into collecting veins at the peripheral region of the ganglion complex. Finally, the veins coursed to the dorsal aspect of the ganglion to drain into the renal and inferior phrenic veins and the inferior vena cava. The capillaries on the coeliac ganglion complex do not possess fenestrations.     

胎儿和新生儿肾上腺的血管构筑

本文采用血管复型扫描电镜,注射墨汁切片光镜下观察和注射铅丹乳胶X线照像3种方法,研究了28例胎儿和新生儿肾上腺的血管构筑。发自膈下动脉、腹主动脉和肾动脉的肾上腺上、中、下动脉及其分支,在肾上腺囊表面和穿过囊的过程中逐级分支,最后形成毛细血管。动脉和毛细血管共同构成囊血管丛,从该丛发出的皮质动脉和髓质动脉,分别分支供给皮质和髓质。从囊血管丛发出的“V”型动脉在皮质中行一段距离后又返回囊中分支。永久性皮质毛细血管网是囊毛细血管的直接延续。在胎儿性皮质中,毛细血管有两个来源,其一是永久性皮质毛细血管的延伸;另一来源是由皮质动脉分支构成。它们共同构成胎儿性皮质毛细血管网。在胎儿性皮质的中部,毛细血管汇成小静脉。中央区的髓质由髓质动脉供血。在皮质中,正在迁移的髓质细胞团由与之伴行的动脉供应。在皮质中形成的小静脉呈向心性行走。其中一部分在近中央区又分为毛细血管,这些毛细血管相互吻合,最后入中央静脉的属支中。这种分布特点属于门脉形式的血管;另一部分属于中央静脉的第一级属支,它们逐级汇合后形成中央静脉主干。中央静脉系呈树枝状,其主干在腺的前面穿出腺后为肾上腺静脉。左侧肾上腺静脉人左肾静脉;右侧的人下腔静脉。而与动脉伴行的肾上腺上、中、下静脉的末级属支与囊毛细血管相连。本研究讨论了胎儿和新生儿肾上腺血管的分布规律,为胎儿内分泌学和肾上腺移植等方面提供了血管形态学基础。     

Multiple variations of the coeliac axis,hepatic and renal vasculature as incidental findings illustrated by MDCTA

Vascular anatomical variations are not uncommon and may affect any organ’s arterial or venous vasculature. The coexistence of variations in different organic systems is less commonly found, but of great clinical significance in a series of clinical conditions like organ transplantation and surgical preoperative planning. Multidetector computed tomography angiography (MDCTA) has emerged as a valuable alternative to the conventional angiography for accurate evaluation of vascular anatomy and pathology. Radiologists should be familiar with each organ’s vascular variations and always report them to the clinician, even if they represent an incidental finding. This case report presents a 52-year-old female patient undergoing abdominal MDCTA for characterization of a renal lesion. This examination revealed the presence of three hilar arteries on the left kidney, a main renal vein in combination with an additional renal vein in both sides along with a replaced right hepatic artery originating from the superior mesenteric artery. Moreover, both inferior phrenic arteries were found originating from the coeliac axis. 3D volume rendering technique images were used in the evaluation of vascular anatomy as illustrated in this case report.     

Development and degeneration of the arterial system in the mesonephros and metanephros of chicken embryos

Background: The general morphology of the mesonephric and metanephric arteries in chicken embryos has already been described previously. Moreover, the general basis of glomerulogenesis has also been established. However, the degeneration of the mesonephric vascular system, and especially glomerular degeneration, have not been well established yet. Also the morpology of the metanephric angiogenic buds has not been studied yet. Methods: Scanning electron microscopy of vascular corrosion casts and critical point dried specimens as well as light microscopy of serially sectioned material has been used in this study. Mesonephric degeneration coincides in time with metanephros growth and maturation in the developmental stages of chicken embryos chosen for this investigation (7.5, 9, 11, and 14 days of incubation). Results: The arterial system of the mesonephros in embryonic chicken is similar to that of the anuran kidney, as described in the literature. The morphology of the degenerating mesonephric glomeruli shows that the glomerular capillaries are more thick, tortuous, and numerous than those in normal glomeruli. The podocytes also show degeneration. The arterial system of the metanephros grows directly from the aorta and from the mesonephric arterial system. During these stages of rapid growth, the metanephros shows angiogenic buds. These angiogenic buds can be either pointed or round blind endings. Conclusions: The distribution and topography of the mesonephric and metanephric arteries is in general accordance with the literature. The process of glomerular degeneration in the mesonephros seems similar to glomerular senescence in man but is different from that of the aged rat glomeruli. The round angiogenic buds observed in the metanephros resemble tumoral angiogenic buds in some aspects. However, both angiogenesis and the degenerative phenomena are part of the normal developmental process. Consequently, the involved mechanisms are probably under sole genetic control. The system studied here offers therefore the possibility to study vascular growth and degeneration on the same model in physiological conditions without application of vasoactive or pathological agents. © 1995 Wiley-Liss, Inc.     

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.     

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.