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Renal artery variations with clinical significance: Multiple renal arteries and their coexistent anatomical abnormalities: A cadaveric study

Year 2024, Volume: 16 Issue: 2, 46 - 54, 31.08.2024
https://doi.org/10.35514/mtd.2024.111

Abstract

Purpose: This cadaveric study aimed to identify the multiple renal arteries and evaluate their association with other anatomical abnormalities. The possible clinical consequences of more than one renal artery were analyzed.
Material - methods: This study was carried out by accessing the Abdominal aorta (AA) of 20 American cadavers [12 males, 8 females, ages 50-96] donated to the C&DA Department of Albert Einstein College of Medicine. From the cadavers in the supine position, the branch points of the renal artery from the abdominal aorta on the right and left sides were checked to see if there was more than one. Renal artery (left side), celiac trunk, superior mesenteric artery, inferior mesenteric artery, and aortic bifurcation were measured in 3 ways: linear, longitudinal, and transverse. The obtained results were assessed using a comparative analysis with earlier research findings documented in the literature.

Results: Among the 20 cadavers included in the study, two males, aged 62 and 80, were found to have two renal arteries on the right side, and both of them are hiler arteries. These multiple renal arteries were coexistent with splenomegaly, tortuosity of the abdominal aorta, and deviation of the vertebral column at the level of the 3rd lumbar vertebra. 94.7% of the cadavers exhibited normal renal arterial anatomy. The most common branching locations of the main renal arteries and multiple renal arteries (MRA) were found find from the abdominal aorta.


Conclusion: Before surgical or radiological procedures in the anatomical region related to and adjacent to renal arteries, knowing the possible renal artery variations in the anatomy of the region is very important to reduce mortality and morbidity during surgical or interventional procedures. Knowing the anatomy of renal arteries and evaluating it radiologically will guide renal transplantation, hepatorenal surgery, interventional radiology, and nephrology the prevention and treatment of many conditions, such as hypertension, and target organ damage.

Ethical Statement

In this study, ethical approval is not required since the study is based on course cadavers from Albert Einstein College of Medicine C&DA Department according to the exemption categories in Enstein-IRB-citation104(d).

Supporting Institution

Albert Eistein College of Medicine, C&DA Department,

Thanks

I would like to express my endless gratitude to all the donors who donated their bodies for education and science in this study and to the AECOM team.

References

  • 1.Ozkan U, Oguzkurt L, Tercan F, Kizilkilic O, Koc Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagnostic and interventional radiology (Ankara, Turkey) 2006; 12(4): 183-186. 2.Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surgical and radiologic anatomy: SRA 2001; 23(1): 33-38.
  • 3.Richard Drake WV. Gray's Anatomy. Gunes Medical Bookstore 2017: 324.
  • 4.Pestemalci T, Mavi A, Yildiz YZ, Yildirim M, Gumusburun E. Bilateral triple renal arteries. Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2009; 20(3): 468-470.
  • 5.Pollack HM, McClennan BL, Dyer R, Kenney PJ: Clinical Urography. Saunders, Philadelphia; 2000. 10.1148/radiology.219.3.r01jn43822
  • 6.Etli M., Avnioglu S., Dikici R. Prevalence of Accessory Renal Artery in Aortic Aneurysms. Van Medical Journal. 2020. 27. 520-524. 10.5505/vtd.2020.53386.
  • 7.Moore KL DA. Clinically Oriented Anatomy. Lippincott Williams & Wilkins Publishers 1999: 286-287.
  • 8.Feller I, Woodburne RT. Surgical anatomy of the abdominal aorta. Ann Surg 1961; 154: 239-52.
  • 9.Letti, R., Levoor, P., Vollala, V. R., Potu, B. K., Ravishankar, M., & Virupaxi, R. Multiple variations of the urogenital vascular system in a single cadaver: a case report. Cases journal, 2008; 1(1), 344.
  • 10.Chung, A. A., Millner, P. R. Accessory Renal Artery Stenosis and Secondary Hypertension. Case reports in nephrology, 2020; 8879165.
  • 11.Davidovic, L. B., Markovic, M., Kostic, D., Zlatanovic, P., Mutavdzic, P., & Cvetic, V. (2018). Open repair of ruptured abdominal aortic aneurysm with associated horseshoe kidney. International angiology : a journal of the International Union of Angiology, 37(6), 471–478.
  • 12.Anson BJ. Morris’ Human Anatomy. 12th Ed., New York, Mc GrawHill Book Company. 1966; 746-47. 13.Sampaio FJ, Passos MA. Renal arteries: An anatomic study for the surgical and the radiologic practice. Surg Radiol Anat. 1992; 14: 113-17.
  • 14.Yufa, A., Mikael, A., Lara, G., Nurick, H., Andacheh, I. Accessory renal arteries involved in atherosclerotic occlusive disease at the aortic bifurcation. Journal of vascular surgery cases and innovative techniques, 2008; 6(3), 425–429.
  • 15.Zarins, C. K., Xu, C., Glagov, S. Atherosclerotic enlargement of the human abdominal aorta. Atherosclerosis, 2001; 155(1), 157–164.
  • 16.Aliyu I. Massive splenomegaly, acute kidney injury, and the challenges of diagnosing hyperractive malarial syndrome in a resource-limited setting. J Med Trop 2017;19, 140-1
  • 17.Gulas, E., Wysiadecki, G., Szymański, J., Majos, A., Stefańczyk, L., Topol, M., et. al. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Archives of medical science : AMS, 2018; 14(2): 442–453.
  • 18.Pradhay, G., Gopidas, G. S., Karumathil P.S., Mathew G., Mathew A. J., Sukumaran T. T., et. al. Prevalence and Relevance of Multiple Renal Arteries: A Radioanatomical Perspective. 2021; Cureus, 13(10): e18957.
  • 19.Kosiński H. Variability of places of origin of the human renal arteries. Folia Morphol (Warsz). 1994;53(2):111-116.
  • 20.Ozan H, Alemdaroglu A, Sinav A, Gümüsalan Y. Location of the ostia of the renal arteries in the aorta. Surg Radiol Anat. 1997;19(4):245-247.
  • 21.Pennington N, Soames RW. The anterior visceral branches of the abdominal aorta and their relationship to the renal arteries. Surg Radiol Anat. 2005;27(5):395-403.
  • 22.Kang K, Ma Y, Jia C, et al. Relationship between Accessory Renal Artery and Clinical Characteristics of Middle-Aged Patients with Primary Hypertension. Int J Hypertens. 2020;2020:7109502. Published 2020 Apr 8.
  • 23.Chan PL, Tan FHS. Renin dependent hypertension caused by accessory renal arteries. Clin Hypertens. 2018;24:15. Published 2018 Nov 1.
  • 24.Davies Er, Sutton D. Hypertension And Multiple Renal Arteries. Lancet. 1965;1(7381):341-344.
  • 25.Takahashi T, Takeuchi K, Ito T, Hayashi S, Qu N, Itoh M. Positional relationships of abdominal aorta landmarks for angiography: observations from the intravascular space. Surg Radiol Anat. 2014;36(7):681-688.
  • 26.Kadotani Y, Okamoto M, Akioka K, Ushigome H, Ogino S, Nobori S, et. al. The management and the outcome of living kidney grafts with multiple arteries. Surg Today. 2005; 35: 459-66.
  • 27.Natsis K, Paraskevas G, Panagouli E, et al. A morphometric study of multiple renal arteries in Greek population and a systematic review. Rom J Morphol Embryol. 2014;55(3 Suppl):1111-1122.
  • 28.Benedetti E, Troppmann C, Gillingham K, Sutherland DE, Payne WD, Dunn DL, et. al. The short- and longterm outcomes of kidney transplants with multiple renal arteries. Ann Surg. 1995; 221: 406-14.
  • 29.Feller I, Woodburne RT. Surgical anatomy of the abdominal aorta. Ann Surg 1961; 154: 239-52.
  • 30.Wadhwa, A. & Soni, S.. (2012). An accessory renal artery from a tortuous abdominal aorta: A case report. Journal of Clinical and Diagnostic Research. 6. 1292-1293.
  • 31.Demir, M., Yesildal, C., Yavuzsan, A. H., Kirecci, S. L., Dokucu, A. I.. First, live donor nephrectomy with abdominal tortuous aorta and two renal arteries: A renal transplantation case report. Urology case reports, 2019; 29: 101097.
  • 32.Malgor, R. D., Oderich, G. S., Vrtiska, T. J., Kalra, M., Duncan, A. A., Gloviczki, P. et. al. A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair. Journal of vascular surgery, 2013; 58(6): 1467-1475.
  • 33.Greenberg JI, Dorsey C, Dalman RL, Lee JT, Harris E, Hernandez-Boussard T, et al. Long-term results after accessory renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg 2012;56:291-7.

Klinik önemi olan renal arter varyasyonları: Çoklu renal arterler ve eşlik eden anatomik varyasyonlar: Bir kadavra çalışması

Year 2024, Volume: 16 Issue: 2, 46 - 54, 31.08.2024
https://doi.org/10.35514/mtd.2024.111

Abstract

Amaç: Bu kadavra çalışmasının amacı multipl renal arterleri tanımlamak ve aynı zamanda diğer anatomik anormallikler ile birlikteliğini değerlendirmekti. Birden fazla arteria renalis’in bulunmasının olası klinik sonuçları analiz edildi.

Metod: Bu çalışma, Albert Einstein College of Medicine C&DA Anabilim Dalı’na bağışlanan 20 Amerikan kadavrasından [12 erkek, 8 kadın, yaşları 50-96] Aorta Abdominalis(AA)’e ulaşılarak gerçekleştirildi. Supin pozisyondaki kadavralardan Arteria renalis’in sağ ve sol tarafta Aorta abdominalis’ten dallanma noktaları, birden fazla sayıda olup olmadıkları kontrol edildi. Arteria renalis(sol taraf), Truıncus coeliacus, arteria(a.) mesenterica superior, a. mesenterica inferior, bifurcatio aorta arasındaki mesafeler, lineer, longitudinal ve transvers olmak üzere 3 şekilde ölçüldü. Elde edilen sonuçlar oranlanarak, lieratürdeki önceki çalışmalarla kıyaslanarak değerlendirildi.

Bulgular: Çalışmaya alınan 20 kadavradan 62 ve 80 yaşında olan iki erkek cinsiyette, ikiside hiler arter olmak üzere sağ tarafta iki adet renal arter olduğu tespit edildi. Multiple renal arterlere, splenomagali, abdominal aorta da ondülan seyir, 3. Lumbal vertebra seviyesinde columna vertebralis’te deviasyon olduğu gözlendi. Hastaların %94,7'si normal renal arter anatomisine sahipti. Ana renal arterlerin ve ARA'nın en sık Aorta abdominalis’ten dallanıyordu.

Sonuç: Arteria renalis ile ilişkili ve komşuluğundaki Anatomik bölgedeki cerrahi veya radyolojik işlemler öncesinde bölge Anatomisindeki olası arteria renalis varyasyonlarının bilinmesi cerrahi veya girişimsel işlemler sırasındaki mortalite ve morbiditeyi azaltmakta çok önemlidir. Renal transplantasyon ve Hepatorenal cerrahi, girişimsel radyoloji, nefroloji başta olmak üzere A.(arteria) renalis anatomisinin bilinerek, radyolojik olarak değerlendirilmesi, hipertansiyon, hedef organ hasarı gibi pek çok kliniğin önlenmesi ve tedavisine kılavuz olacaktır.

References

  • 1.Ozkan U, Oguzkurt L, Tercan F, Kizilkilic O, Koc Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagnostic and interventional radiology (Ankara, Turkey) 2006; 12(4): 183-186. 2.Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surgical and radiologic anatomy: SRA 2001; 23(1): 33-38.
  • 3.Richard Drake WV. Gray's Anatomy. Gunes Medical Bookstore 2017: 324.
  • 4.Pestemalci T, Mavi A, Yildiz YZ, Yildirim M, Gumusburun E. Bilateral triple renal arteries. Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2009; 20(3): 468-470.
  • 5.Pollack HM, McClennan BL, Dyer R, Kenney PJ: Clinical Urography. Saunders, Philadelphia; 2000. 10.1148/radiology.219.3.r01jn43822
  • 6.Etli M., Avnioglu S., Dikici R. Prevalence of Accessory Renal Artery in Aortic Aneurysms. Van Medical Journal. 2020. 27. 520-524. 10.5505/vtd.2020.53386.
  • 7.Moore KL DA. Clinically Oriented Anatomy. Lippincott Williams & Wilkins Publishers 1999: 286-287.
  • 8.Feller I, Woodburne RT. Surgical anatomy of the abdominal aorta. Ann Surg 1961; 154: 239-52.
  • 9.Letti, R., Levoor, P., Vollala, V. R., Potu, B. K., Ravishankar, M., & Virupaxi, R. Multiple variations of the urogenital vascular system in a single cadaver: a case report. Cases journal, 2008; 1(1), 344.
  • 10.Chung, A. A., Millner, P. R. Accessory Renal Artery Stenosis and Secondary Hypertension. Case reports in nephrology, 2020; 8879165.
  • 11.Davidovic, L. B., Markovic, M., Kostic, D., Zlatanovic, P., Mutavdzic, P., & Cvetic, V. (2018). Open repair of ruptured abdominal aortic aneurysm with associated horseshoe kidney. International angiology : a journal of the International Union of Angiology, 37(6), 471–478.
  • 12.Anson BJ. Morris’ Human Anatomy. 12th Ed., New York, Mc GrawHill Book Company. 1966; 746-47. 13.Sampaio FJ, Passos MA. Renal arteries: An anatomic study for the surgical and the radiologic practice. Surg Radiol Anat. 1992; 14: 113-17.
  • 14.Yufa, A., Mikael, A., Lara, G., Nurick, H., Andacheh, I. Accessory renal arteries involved in atherosclerotic occlusive disease at the aortic bifurcation. Journal of vascular surgery cases and innovative techniques, 2008; 6(3), 425–429.
  • 15.Zarins, C. K., Xu, C., Glagov, S. Atherosclerotic enlargement of the human abdominal aorta. Atherosclerosis, 2001; 155(1), 157–164.
  • 16.Aliyu I. Massive splenomegaly, acute kidney injury, and the challenges of diagnosing hyperractive malarial syndrome in a resource-limited setting. J Med Trop 2017;19, 140-1
  • 17.Gulas, E., Wysiadecki, G., Szymański, J., Majos, A., Stefańczyk, L., Topol, M., et. al. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Archives of medical science : AMS, 2018; 14(2): 442–453.
  • 18.Pradhay, G., Gopidas, G. S., Karumathil P.S., Mathew G., Mathew A. J., Sukumaran T. T., et. al. Prevalence and Relevance of Multiple Renal Arteries: A Radioanatomical Perspective. 2021; Cureus, 13(10): e18957.
  • 19.Kosiński H. Variability of places of origin of the human renal arteries. Folia Morphol (Warsz). 1994;53(2):111-116.
  • 20.Ozan H, Alemdaroglu A, Sinav A, Gümüsalan Y. Location of the ostia of the renal arteries in the aorta. Surg Radiol Anat. 1997;19(4):245-247.
  • 21.Pennington N, Soames RW. The anterior visceral branches of the abdominal aorta and their relationship to the renal arteries. Surg Radiol Anat. 2005;27(5):395-403.
  • 22.Kang K, Ma Y, Jia C, et al. Relationship between Accessory Renal Artery and Clinical Characteristics of Middle-Aged Patients with Primary Hypertension. Int J Hypertens. 2020;2020:7109502. Published 2020 Apr 8.
  • 23.Chan PL, Tan FHS. Renin dependent hypertension caused by accessory renal arteries. Clin Hypertens. 2018;24:15. Published 2018 Nov 1.
  • 24.Davies Er, Sutton D. Hypertension And Multiple Renal Arteries. Lancet. 1965;1(7381):341-344.
  • 25.Takahashi T, Takeuchi K, Ito T, Hayashi S, Qu N, Itoh M. Positional relationships of abdominal aorta landmarks for angiography: observations from the intravascular space. Surg Radiol Anat. 2014;36(7):681-688.
  • 26.Kadotani Y, Okamoto M, Akioka K, Ushigome H, Ogino S, Nobori S, et. al. The management and the outcome of living kidney grafts with multiple arteries. Surg Today. 2005; 35: 459-66.
  • 27.Natsis K, Paraskevas G, Panagouli E, et al. A morphometric study of multiple renal arteries in Greek population and a systematic review. Rom J Morphol Embryol. 2014;55(3 Suppl):1111-1122.
  • 28.Benedetti E, Troppmann C, Gillingham K, Sutherland DE, Payne WD, Dunn DL, et. al. The short- and longterm outcomes of kidney transplants with multiple renal arteries. Ann Surg. 1995; 221: 406-14.
  • 29.Feller I, Woodburne RT. Surgical anatomy of the abdominal aorta. Ann Surg 1961; 154: 239-52.
  • 30.Wadhwa, A. & Soni, S.. (2012). An accessory renal artery from a tortuous abdominal aorta: A case report. Journal of Clinical and Diagnostic Research. 6. 1292-1293.
  • 31.Demir, M., Yesildal, C., Yavuzsan, A. H., Kirecci, S. L., Dokucu, A. I.. First, live donor nephrectomy with abdominal tortuous aorta and two renal arteries: A renal transplantation case report. Urology case reports, 2019; 29: 101097.
  • 32.Malgor, R. D., Oderich, G. S., Vrtiska, T. J., Kalra, M., Duncan, A. A., Gloviczki, P. et. al. A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair. Journal of vascular surgery, 2013; 58(6): 1467-1475.
  • 33.Greenberg JI, Dorsey C, Dalman RL, Lee JT, Harris E, Hernandez-Boussard T, et al. Long-term results after accessory renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg 2012;56:291-7.
There are 31 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Article
Authors

Hürriyet Ercan Çetinok 0000-0001-7083-966X

Publication Date August 31, 2024
Submission Date August 7, 2024
Acceptance Date August 27, 2024
Published in Issue Year 2024 Volume: 16 Issue: 2

Cite

Vancouver Ercan Çetinok H. Renal artery variations with clinical significance: Multiple renal arteries and their coexistent anatomical abnormalities: A cadaveric study. Maltepe tıp derg. 2024;16(2):46-54.