How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver?

This study investigates the relevant anatomy for applying the hanging maneuver to hepatectomy by an anterior approach, where liver mobilization is not possible. Using 176 cadaveric livers, we morphometrically investigated the distribution of venous openings within the retrohepatic portion of the inferior vena cava (IVC); next, we conducted a series of experiments to identify which course for insertion of a pair of forceps preserved the thickest of these veins. After anterior dissection of the liver, we carried out an anterior incision along a plane within an area free of venous openings in the IVC. The area free of venous openings was between the thickest caudate vein and the inferior right hepatic vein (IRHV), and averaged 16.2 mm in width. When forceps were inserted along the rightward course connecting the right inferior angle of the right lobe and the same pocket-like space between the terminals of the middle and right hepatic veins, the caudate vein was very likely to be preserved, whereas the IRHV was not. In contrast, the leftward course connecting the gallbladder fossa and the pocket-like space provided an almost opposite incidence of damage. The portal territory of the hilar bifurcation was most likely to be damaged during a virtual incision along an avascular plane; however, the caudate branch of left portal origin was rarely damaged. The rightward course may be the best method for forceps insertion in cases where there is no IRHV. To preserve the caudate vein and the IRHV, taping on the right side of the IRHV and retracting to the right, or changing the direction of the forceps from leftward to rightward when the tip of the forceps is anterior to the IVC is recommended. The hanging maneuver by an anterior approach without mobilization is convenient for right or left hepatectomy for large tumors or hardened liver.     

Infra‐renal angles,entry into inferior vena cava and vertebral levels of renal veins

Current norms for renal vasculature hold true in only half the population. Standard textbooks perpetuate old misconceptions regarding renal venous anatomy. This study is aimed to determine left and right infra‐renal angles (L‐IRA, R‐IRA); entry level of renal veins into the inferior vena cava (IVC), and height of IVC under renal vein influence; and their vertebral level. One hundred morphologically normal en‐bloc renal specimens randomly selected from post‐mortem examinations were dissected and resin casted. IRA were also measured from venograms of 32 adult and 11 foetal cadavers, as were vertebral entry levels. IRA measurements (degrees) were as follows: left, 55° ± 16° (20°–102°); right, 60° ± 17° (10°–93°). Left vein entered IVC higher than right 54%, lower 36%, and opposite each other 10%. Vertical distance between lower borders of veins was 1.0 ± 0.9 cm. Vertical distance of IVC under renal vein influence was 2.3 ± 1.0 cm. Vertebral level of veins in adults lies between TI2–L2. In foetuses, IRA was as follows: left, 65° ± 12° (45°–90°); right, 58° ± 7° (40°–70°); vertebral level between T12 and L3. Similar IRA values from literature noted on right, 51° (26°–100°); differences on left, 77° (43° –94°), clearly differing from Williams et al. (Gray's Anatomy, 37^th ed, 1989) statement that renal veins “open into the inferior vena cava almost at right angles.” Large variations of IRA are not surprising since kidneys are considered normally “floating viscera,” varying position with posture and respiratory movement as well as in live vs. cadaveric subjects. The entry level into the IVC also differs from Williams et al. This study uniquely quantitated actual height difference between lower borders of left and right veins. The data presented appears to be the first documentation of vertebral level of entry of renal veins into IVC in foetuses. These findings are clinically important for the angiographer, catheter design, and planning porto‐renal shunt procedures. Anat Rec 256:202–207, 1999. © 1999 Wiley‐Liss, Inc.     

Infrahepatic inferior caval and azygos vein formation in mammals with different degrees of mesonephric development

Controversies regarding the development of the mammalian infrahepatic inferior caval and azygos veins arise from using topography rather than developmental origin as criteria to define venous systems and centre on veins that surround the mesonephros. We compared caudal‐vein development in man with that in rodents and pigs (rudimentary and extensive mesonephric development, respectively), and used Amira 3D reconstruction and Cinema 4D‐remodelling software for visualisation. The caudal cardinal veins (CCVs) were the only contributors to the inferior caval (IVC) and azygos veins. Development was comparable if temporary vessels that drain the large porcine mesonephros were taken into account. The topography of the CCVs changed concomitant with expansion of adjacent organs (lungs, meso‐ and metanephroi). The iliac veins arose by gradual extension of the CCVs into the caudal body region. Irrespective of the degree of mesonephric development, the infrarenal part of the IVC developed from the right CCV and the renal part from vascular sprouts of the CCVs in the mesonephros that formed ‘subcardinal’ veins. The azygos venous system developed from the cranial remnants of the CCVs. Temporary venous collaterals in and around the thoracic sympathetic trunk were interpreted as ‘footprints’ of the dorsolateral‐to‐ventromedial change in the local course of the intersegmental and caudal cardinal veins relative to the sympathetic trunk. Interspecies differences in timing of the same events in IVC and azygos‐vein development appear to allow for proper joining of conduits for caudal venous return, whereas local changes in topography appear to accommodate efficient venous perfusion. These findings demonstrate that new systems, such as the ‘supracardinal’ veins, are not necessary to account for changes in the course of the main venous conduits of the embryo.     

肝尾状叶及其血管的断层解剖学研究

为给肝尾状叶疾病的影像诊断和外科手术提供形态学依据，本文利用成人腹部连续横断层标本22例、矢状断层标本14例和冠状断层标本5例研究了肝尾状叶及其血管的断层解剖。肝尾状叶有5面，在外形上可分为固有肝尾状叶(Spigelian叶)、腔静脉旁部和尾状突三部分。固有肝尾状叶，在横断面上，14例(63．6％)伸出腔静脉后突，11例(50％)出现孤立乳头突现象；在矢状断面上，4例(28．6％)下端出现分叉。在15例(68．2％)横断层和12例(85．7％)矢状断层标本上，可见肝尾状叶鞘系，主要出现于肝门静脉左支横部层面。在断层标本上，可见1～3支尾状叶静脉，大部分汇入下腔静脉肝后段的中、下份。粗大的肝右后下静脉分别见于10例(45.5％）横断层、4例(28.6％）矢状断层和l例冠状断层标本上。此外，文内还详细探讨了肝尾状叶在横、矢、冠状断面上的识别、毗邻及其在影像诊断和在肝切除术中的意义。     

腹腔镜下肝门血流阻断肝切除术的解剖学基础

目的　探讨腹腔镜下肝门血流阻断在肝切除术（LH）的解剖基础及手术路径。 方法　解剖尸体肝脏,分离血流阻断所涉及各肝门结构,观察在二维平面中毗邻,测量在肝外长度及夹角;观察LH视频中肝门结构,总结镜下的位置及特征。 结果　肝动脉平面低于肝管（90%）,肝门静脉分叉位置固定于后方;肝左和肝中静脉在肝外大多共干（90%）,肝右静脉与共干间存在间隙,与肝后下腔静脉(IVC)前方相通;肝短静脉位于IVC两侧,有（7±3）支;IVC韧带在尸体中易忽略,活体中较明显,为包绕IVC的膜性结构,厚度个体差异大;各结构在肝外长度及夹角为肝门血流阻断提供足够空间;镜下各结构位置及特征与实体比较有特殊性。 结论　LH中应用肝门血流阻断有解剖依据及路径遵循。     

Topographic anatomy of the fetal inferior vena cava,coronary sinus,and pulmonary veins: Variations in Chiari's network

To understand anomalies in Chiari's network better, we assessed the topographical anatomy of the fetal inferior vena cava (IVC), coronary sinus, and atria. We examined sagittal serial paraffin sections of 15 human fetuses of crown–rump length 24–36 mm, corresponding to a gestational age of 8 weeks. Although their outflow tract morphologies were similar, these 15 specimens could be classified into two groups. In eight specimens, the left common cardinal vein reached the body wall, whereas in the other seven the vein was obliterated near the left pulmonary vein. Irrespective of the group in which the specimen was included, the anteroposterior arrangement of the coronary sinus, the sinus septum (septum), and the right sinus valve (right valve) could be classified into three types: the right valve–septum–coronary sinus arrangement in seven specimens; the right valve–coronary sinus–septum arrangement in five; and the coronary sinus–right valve–septum arrangement in three. Depending on differences in topographical anatomy, the sinus septum separated the coronary sinus opening from either the right or the left atrium. Likewise, the coronary sinus opening was either adjacent to or distant from the IVC terminal. Rather than the counter‐side position of the right valve being at the IVC terminal, the left sinus valve protruded leftward, forming an incomplete interatrial septum. Fetal variations seemed to be closely connected with individual variations and a high frequency of Chiari's network anomalies in adults. Clin. Anat. 28:627–637, 2015. © 2014 Wiley Periodicals, Inc.     

Quantitative anatomy of the large variant right hepatic vein: A systematic three-dimensional analysis

Anatomical variations of the right hepatic vein, especially large variant right hepatic veins (≥5 mm), have important clinical implications in liver transplantation and resection. This study aimed to evaluate anatomical variations of the right hepatic vein using quantitative three-dimensional visualization analysis. Computed tomography images of 650 patients were retrospectively analyzed, and three-dimensional visualization was applied using the derived data to analyze large variant right hepatic veins. The proportion of the large variant right hepatic vein was 16.92% (110/650). According to the location and number of the variant right hepatic veins, the configuration of the right hepatic venous system was divided into seven subtypes. The length of the retrohepatic inferior vena cava had a positive correlation with the diameter of the right hepatic vein (rs = 0.266, p = 0.001) and the variant right hepatic veins (rs = 0.211, p = 0.027). The diameter of the right hepatic vein was positively correlated with that of the middle hepatic vein (rs = 0.361, p < 0.001), while it was inversely correlated with that of the variant right hepatic veins (rs = −0.267, p = 0.005). The right hepatic vein diameter was positively correlated with the drainage volume (rs = 0.489, p < 0.001), while the correlation with the variant right hepatic veins drainage volume was negative (rs = −0.460, p < 0.001). The number of the variant right hepatic veins and their relative diameters were positively correlated (p < 0.001). The volume and percentage of the drainage area of the right hepatic vein decreased significantly as the number of the variant right hepatic vein increased (p < 0.001). The findings of this study concerning the variations of the hepatic venous system may be useful for the surgical planning of liver resection or transplantation.     

The relationship between Doppler indices from inferior vena cava and hepatic veins in normal human fetuses

This study was conducted to determine the gestational age-related reference range of the preload index [peak velocity during atrial contraction (A)/peak velocity during ventricular systole (S)] for the inferior vena cava (IVC), the right hepatic vein, the middle hepatic vein and the left hepatic vein. The slope and the intercept of the regression line for each preload index were compared among the 4 veins using analysis of covariance. Doppler measurements were obtained for the 4 veins of 316 normal fetuses at 22-40 weeks of gestation. A and S values were measured from the recorded flow velocity waveform of each vein and the A/S ratio was calculated as the preload index. The regression lines for the preload index of the 4 veins decreased gradually throughout gestation. Analysis of covariance revealed no significant differences in the slopes of the regression lines for the 4 veins. However, the intercepts of the regression lines for all hepatic veins were significantly higher than that of the regression line for the IVC (P<0.0001), with the difference ranging from 0.024 to 0.033. There were no significant differences among the intercepts of the regression lines for different hepatic veins. We concluded that the relationship between the preload index and the duration of gestation was statistically similar for all hepatic veins, and strongly resembled that for the IVC.     

Topographical anatomy of Spiegel's lobe and its adjacent organs in mid‐term fetuses: Its implication on the development of the lesser sac and adult morphology of the upper abdomen

At 8–16 weeks of gestation, Spiegel's lobe of the caudate lobe appears as a sac‐like herniation of the liver parenchyma between the inferior vena cava and ductus venosus or Arantius' duct. In 5 of 11 fetuses at 20–30 weeks of gestation, we found that an external notch was formed into the posterior aspect of the caudate lobe by a peritoneal fold containing the left gastric artery. This notch appeared to correspond to that observed in adults, which is usually seen at the antero‐inferior margin of the lobe after rotation of the lobe along the horizontal or transverse axis. However, the notch did not accompany two of the three fetuses in which the left hepatic artery originated from the left gastric artery. Notably, until 9–10 weeks of gestation, the inferior and left part of Spiegel's lobe rode over the hepatoduodenal ligament and protruded medially into the lesser sac (bursa omentalis) behind the stomach. Thus, the fetal Winslow's foramen was located at the “superior” side of the ligament. However, as seen in adults, the protruding Spiegel's lobe was located at the posterior side of the lesser omentum. Therefore, a hypothetical rotation along the transverse axis in the later stages of development seems necessary to explain this repositioning. Considering that Spiegel's lobe develops faster than surrounding structures, it is likely that the lesser sac resulting from the rotation of the gastrointestinal tract, which actively contributes to facilitate the growth of the Spiegel lobe. Clin. Anat. 23:712–719, 2010. © 2010 Wiley‐Liss, Inc.     

An anatomical classification of the variations of the inferior phrenic vein

The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic vein (IPV). However, in the last decade, an increasing number of reports have arisen, with reference to the endoscopic embolization of esophageal and paraesophageal varices, as well as venous drainage of hepatocellular carcinomas (HCC). The IPV is one of the major sources of collateral venous drainage in portal hypertension and HCC. The aim of this study was to identify the origin and distribution of the IPVs (right and left), both in normal and (selective) pathological cases. We have examined 300 formalin-fixed adult cadavers, without any visible gastrointestinal disease, and 30 cadavers derived from patients with HCC. The right IPV drained into the following: the inferior vena cava (IVC) inferior to the diaphragm in 90%, the right hepatic vein in 8%, and the IVC superior to the diaphragm in 2%. The left IPV drained into the following: the IVC inferior to the diaphragm in 37%, the left suprarenal vein in 25%, the left renal vein in 15%, the left hepatic vein in 14%, and both the IVC and the left adrenal vein in 1% of the specimens. The IPVs possessed four notable tributaries: anterior, esophageal, lateral and medial. The right IPV served as one of the major extrahepatic draining veins for all 30 cases of HCC. These findings could have potential clinical implications in the transcatheter embolization of esophageal and paraesophageal varices, as well as in mobilizing the supradiaphragmatic segment of IVC.     

Anatomy of the portal branches and the hepatic veins in the caudate lobe of the liver

The objective of this study was to analyze the caudate portal branches and their relationships with the hepatic caudate veins and propose a new nomenclature for the caudate branches based on their territory of distribution. We realized the fine dissection of the veins of the caudate lobe in 40 human livers fixed and preserved in formalin. In 15/40 (37.5%) cases there was a single branch to the caudate lobe. In 25/40 (62.5%) cases there was more than one branch, with a posterior caudate branch in 20/40 (50%) cases, an anterior caudate branch in 15/40 (37.5%) cases, a left caudate branch in 14/40 (35%) cases, and a right caudate branch in 8/40 (20%) cases. The most frequent combination detected (11/40, 27.5% of cases) was that of the posterior and anterior branches. The venous drainage of the caudate lobe and its papillary process was provided by the superior caudate hepatic vein in 23/40 (57.5%) cases, by the middle caudate vein in 35/40 (87.5%) cases (which was the only vein in 12/35 cases), and by the inferior caudate vein in 16/40 (40%) cases. In 11/40 (12.5%) cases there were accessory caudate veins, which emptied into the left and intermediate hepatic veins. The portal branches and the hepatic veins related to the caudate process were studied. In conclusion, the new nomenclature analyzes more precisely the distribution of the caudate portal branches.     

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: A case report

Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.     

Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy

Laparoscopic adrenalectomy (LA) is the procedure of choice for most adrenal tumors. An important part of LA is the early identification and ligation of the adrenal veins. The venous drainage from each adrenal gland is usually via a single vein: the right vein draining into the inferior vena cava (IVC) and the left vein into the left renal vein. Although infrequent, variable venous drainage has been documented. The aim of the study was to clarify if LA identified venous drainage and its variants. Between January 1999 and January 2008, 142 consecutive patients underwent LA. Adrenal vein anatomy was documented on a prospective database. In total, 142 patients underwent 162 LA (right = 62, left = 66, bilateral = 17). All adrenal veins were identified at the time of laparoscopy. For 157 LA, the adrenal venous drainage was constant: right vein drained into the IVC and left vein drained into left renal vein. Five patients had adrenal vein variants: two right veins draining separately into IVC (n = 1), two right veins draining into the IVC and right renal vein (n = 1), and two left veins draining separately into the left renal vein (n = 3). Adrenal vein variants were present in patients with phaeochromocytomas (n = 4) or adrenocortical carcinoma (n = 1). The laparoscopic approach allowed an excellent view of the main adrenal venous anatomy. This has helped confirm the constant nature of the venous drainage and successfully identify variant adrenal veins.     

Preureteric inferior vena cava with possible rudiment of the proper inferior vena cava

A right single preureteric inferior vena cava (IVC) was found in the cadaver of a 77-year-old Japanese male during a student dissection course at Kumamoto University School of Medicine in 2003. The ureter emerged from the lower end of the hilum of the right kidney at the second lumbar vertebral level. It ran inferomedially to pass behind the IVC, and turned inferolaterally to cross the vein superficially at the level of the third to the fourth lumbar vertebrae. Then, the ureter was situated to the right of the IVC, and descended ordinarily. The second lumbar vein of each side united bilaterally, as did the third lumbar veins. The common stem of the second lumbar veins drained into the left side of the IVC posterolaterally at the level of the second intervertebral disc, and the third common stem opened into the left border of the IVC at the fourth lumbar vertebral level. The ureter hooked around the IVC between the openings of those common stems. There was a small continuation (0.2 mm in diameter) between the left second lumbar and the right third lumbar veins along the vertebral column slightly right of the midline. It passed superficial to the right third lumbar artery, as did the IVC. The right testicular vein opened into the IVC at the level of the lower end of the third lumbar vertebral body. Generally, the level of the opening of the gonadal vein corresponds to the level of the caudal end of the remaining subcardinal vein, but it is lower than usual in this case. Furthermore, the segment from the confluence of the common iliac veins to the common trunk of the third lumbar veins, and to the small continuation can be regarded as the proper IVC, and the part where the ureter hooks around it may have derived from the anastomosis between the common trunk of the third lumbar veins and the subcardinal vein.     

肝尾状叶脉管构筑的应用解剖

应用55例成人肝剥离标本及45例胎儿、新生儿肝管道铸型,研究了肝尾状叶的鞘系及静脉回流。尾状叶有两个恒定的蒂、接受左、右侧鞘系的双重供应,以左侧为主;而尾状突主要由右后叶鞘系分布。15例肝铸型标本的尾状叶左、右侧动脉形成吻合弓。尾状叶动脉供应形式可分为三种,静脉可分为三型并直接汇入下腔静脉。由于血管吻合的存在,在病理状态下,尾状叶也应是沟通门一腔静脉的桥梁。     

妊娠后期胎儿肝静脉发育的多普勒超声研究

目的:利用彩色多普勒超声观察妊娠后期胎儿肝静脉的发育状况,从而为肝发育异常性疾病的诊断及治疗提供依据.方法:选择临床及常规超声检查排除各种病变的正常单胎妊娠胎儿118例,孕龄26～40周;采用多功能彩色多普勒超声显像仪进行扫查,观察胎儿肝左、中、右静脉汇入下腔静脉的类型,肝静脉的内径与属支、相互夹角以及血流动力学的状态.记录相关数值并进行分析.结果:肝中静脉与肝左静脉合干后汇入下腔静脉(Ⅰ型)者57例(48.3%),肝左、中、右静脉分别汇入下腔静脉(Ⅱ型)者53例(44.9%),肝中、右静脉合干或出现肝右后静脉等(Ⅲ型)者8例(6.8%).随孕周增加,肝静脉内径增加,肝左、中、右静脉内径分别为(0.34±0.04)cm、(0.35±0.04)cm、(0.36±0.05)cm,与孕周有较高的相关性.可观察到的肝静脉属支1～4支不等.肝右静脉与肝中静脉之间的夹角为(56.8±14.2)°,肝中静脉与肝左静脉之间的夹角为(50.7±19.4)°,肝左静脉与肝右静脉之间的夹角为(98.4±20.3)°.肝静脉和下腔静脉血流频谱为三相,随孕周增加a/s值逐渐减小.以上各数值未见明显性别差异.结论:胎儿肝静脉发育状况与成人不同,胎儿肝静脉属支变异较大.本研究可以丰富与完善肝静脉发育影像学知识,提高肝静脉发育异常胎儿临床诊断水平.     

肝尾状叶切除术中寻找肝静脉的探讨

目的　为肝尾状叶切除术提供解剖学依据。方法　选择 6 0例肝脏标本 ,对紧贴尾状叶的肝中、肝左、肝右静脉段进行解剖和形态观测。结果　紧贴尾状叶的肝中、肝左、肝右静脉从下至上距尾状叶脏面的距离越来越小 ,从下至上彼此的间距亦越来越小 ;肝中、肝左、肝右静脉不在同一平面 5 2例 (8 6 7% )。结论　在尾状叶切除术中 ,先找到肝中静脉末端之后 ,才能更容易寻找肝中、肝左、肝右静脉     

A review of the anatomy and clinical significance of adrenal veins

The adrenal veins may present with a multitude of anatomical variants, which surgeons must be aware of when performing adrenalectomies. The adrenal veins originate during the formation of the prerenal inferior vena cava (IVC) and are remnants of the caudal portion of the subcardinal veins, cranial to the subcardinal sinus in the embryo. The many communications between the posterior cardinal, supracardinal, and subcardinal veins of the primordial venous system provide an explanation for the variable anatomy. Most commonly, one central vein drains each adrenal gland. The long left adrenal vein joins the inferior phrenic vein and drains into the left renal vein, while the short right adrenal vein drains immediately into the IVC. Multiple variations exist bilaterally and may pose the risk of surgical complications. Due to the potential for collaterals and accessory adrenal vessels, great caution must be taken during an adrenalectomy. Adrenal venous sampling, the gold standard in diagnosing primary hyperaldosteronism, also requires the clinician to have a thorough knowledge of the adrenal vein anatomy to avoid iatrogenic injury. The adrenal vein acts as an important conduit in portosystemic shunts, thus the nature of the anatomy and hypercoagulable states pose the risk of thrombosis. Clin. Anat. 27:1253–1263, 2014. © 2014 Wiley Periodicals, Inc.     

Breathing Life into the Cadaver: Introducing Air Dissection As a New Teaching and Dissecting Method for the Venous System

Air insufflation has been used for various surgical procedures such as during laparoscopy. We hypothesized that the use of pressurized air might enable cadaveric dissection to differentiate smaller veins better than traditional dissection techniques. In three fresh‐frozen cadavers, the inferior vena cava (IVC) and right or left femoral veins were exposed just distal to the inguinal ligament and a needle placed into one of them. Pressurized air was then placed into the cannulated femoral vein using an air compressor. In all specimens, the IVC and most of its tributaries, both left and right sides, were clearly insufflated. When the IVC was traced superiorly by resecting the diaphragm through the caval foramen, the right atrium and ventricle were also found to be dilated. Additionally, venous variants that would have not been obvious without dilatation of the IVC were identified. Air dissection of the venous system in fresh‐frozen cadavers aids in anatomical dissection. Such a model might also serve as a surgical training model and teaching tool as it better mimics life‐like anatomy and physiology. We term this technique “cadaveric air dissection.” Clin. Anat. 32:566–572, 2019. © 2019 Wiley Periodicals, Inc.     

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.