Anatomical Variations of Renal Artery in Patients Undergoing Computed Tomography of Abdomen: A Hospital-based Cross-sectional Study
Abstract
Introduction: Renal vasculature is known for presenting a wide range of variations. Knowledge of different anatomical variations helps the surgeon prevent possible intraoperative complications. Computed Tomography (CT) is an excellent imaging modality providing detailed anatomy of the renal artery. This study aimed to evaluate renal arterial variations in individuals undergoing abdominal CT examination. Methods: This was a hospital-based cross-sectional study on 400 consecutive patients who underwent abdominal CT examination in a medical college in Nepal. The number of patients with normal and any arterial variations was noted. Accessory renal artery (hilar and polar artery) and any pre-hilar branching were evaluated. Results: Among 400 patients, 271 (67.75%) individuals had normal renal artery supply and 129 (32.25%) had variations. Among 129 individuals (79 males and 50 females) with artery variations, 93 (72.09%) had unilateral and 36 (27.91%) had bilateral variations. The most common unilateral variation was a single polar artery in 66 (70.97%) cases, pre-hilar branching in 18 (19.35%), accessory hilar artery in 7 (7.53%) and dual polar arteries in 2 (2.15%). In those with bilateral arterial variations, the right and left kidneys showed polar artery in 25 (69%) and 30 (83%), pre-hilar branching in 6 (17%) and 2 (6%), and accessory hilar in 5 (14%) and 4 (11%) cases respectively. Conclusion: Renal artery variation was observed in approximately one-third of individuals. Unilateral variation was more common than bilateral and polar artery was the most common arterial variant.
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References
Beregi JP, Mauroy B, Willoteaux S, Mounier- Vehier C, Rémy-Jardin M, Francke JP. Anatomic variation in the origin of the main renal arteries: Spiral CTA evaluation. Eur Radiol. 999;9(7):1330-4. PMID: 10460369 DOI: https://doi.org/10.1007/s003300050843
Hazirolan T, Öz M, Türkbey B, Karaosmanoǧlu AD, Oǧuz BS, Canyiǧit M. CT angiography of the renal arteries and veins: Normal anatomy and variants. Diagn Interv Radiol. 2011;17(1):67- 73. PMID: 20151356 DOI: https://doi.org/10.4261/1305-3825.dir.2902-09.1
Moore KL, Persaud TVN Torchia MG. The developing Human- Clinically Oriented Embryology. 9 th ed. Philadelphia, USA: Elsevier saunders, 2013.
Rao TR, R. Aberrant renal arteries and its clinical significance: a case report. International Journal of Anatomical Variations. 2011;4(1):37- 9. Available from: https://www.pulsus.com/scholarly-articles/aberrant-renal-arteries-and-its-clinical-significance-a-case-report.pdf
Flors L, Leiva-Salinas C, Ahmad EA, Norton PT, Turba UC, Bozlar U, et al. MD CT angiography and MR angiography of nonatherosclerotic renal artery disease. Cardiovasc Intervent Radiol. 2011;34(6):1151-64. PMID: 21681628 DOI: https://doi.org/10.1007/s00270-011-0202-2
Türkvatan A, Akinci S, Yildiz S, Olçer T, Cumhur T. Multidetector computed tomography for preoperative evaluation of vascular anatomy in living renal donors. Surg Radiol Anat. 2009;31(4):227-35. PMID: 18953477 DOI: https://doi.org/10.1007/s00276-008-0428-0
Williams PL, Warwick R, Dyson M, Bannister LH. Gray’s Anatomy. 37th ed. Churchill Livingstone. Edinburgh, 1989.
Kawamoto S, Montgomery RA, Lawler LP, Horton KM, Fishman EK. Multi-detector row CT evaluation of living renal donors prior to laparoscopic nephrectomy. Radiographics. 2004;24(2):453-66. PMID: 15026593 DOI: https://doi.org/10.1148/rg.242035104
Hänninen EL, Denecke T, Stelter L, Pech M, Podrabsky P, Pratschke J, et al. Preoperative evaluation of living kidney donors using multirow detector computed tomography: Comparison with digital subtraction angiography and intraoperative findings. Transpl Int. 2005;18(10):1134-41. PMID: 16162099 DOI: https://doi.org/10.1111/j.1432-2277.2005.00196.x
Urban BA, Ratner LE, Fishman EK. Three-dimensional volume-rendered CT angiography of the renal arteries and veins: Normal anatomy, variants, and clinical applications. Radiographics. 2001;21(1):373-86. PMID: 11259702 DOI: https://doi.org/10.1148/radiographics.21.2.g01mr19373
Platt JF, Ellis JH, Korobkin M, Reige K. Helical CT evaluation of potential kidney donors: Findings in 154 subjects. AJR Am J Roentgenol. 1997;169(5):1325-30. PMID: 9353451 DOI: https://doi.org/10.2214/ajr.169.5.9353451
Hyare H, Desigan S, Nicholl H, Guiney MJ, Brookes JA, Lees WR. Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease. Eur J Radiol. 2006;59(2):295-300. PMID: 16542810 DOI: https://doi.org/10.1016/j.ejrad.2006.02.006
Reginelli A, Somma F, Izzo A, Urraro F, D’andrea A, Grassi R, et al. Renovascular anatomic variants at CT angiography. Int Angiol. 2015;34(6 Suppl 1):36-42. PMID: 26498890
Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: An analysis with multidetector CT angiography. Br J Radiol. 2010;83(992):661-7. PMID: 20551256 DOI: https://doi.org/10.1259/bjr/21236482
Ozkan U, Oǧuzkurt L, Tercan F, Kizilkiliç O, Koç Z, Koca N. Renal artery origins and variations: Angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol. 2006;12(4):183-6. PMID: 17160802
Tardo DT, Briggs C, Ahern G, Pitman A, Sinha S. Anatomical variations of the renal arterial vasculature: An Australian perspective. J Med Imaging Radiat Oncol. 2017;61(5):643-9. PMID: 28466967 DOI: https://doi.org/10.1111/1754-9485.12618
Raman SS, Pojchamarnwiputh S, Muangsomboon K, Schulam PG, Gritsch HA, Lu DSK. Surgically relevant normal and variant renal parenchymal and vascular anatomy in preoperative 16-MDCT evaluation of potential laparoscopic renal donors. AJR Am J Roentgenol. 2007;188(1):105-14. PMID: 17179352 DOI: https://doi.org/10.2214/ajr.05.1002
Munnusamy K, Kasirajan SP, Gurusamy K, Raghunath G, Bolshetty SL, Chakrabarti S, et al. Variations in branching pattern of renal artery in kidney donors using CT angiography. J Clin Diagn Res. 2016;10(3):AC01-3. PMID: 27134847 DOI: https://doi.org/10.7860/jcdr/2016/16690.7342
Toro JSC, Prada G, Takeuchi SYR, Pachecho R, Baena G, Granados AM. Anatomic variations of the renal arteries from a local study population using 3D computed tomography angiography reconstruction images from a reference hospital in Cali, Colombia. Artery Research. 2016;14(C):22-6. DOI: https://dx.doi.org/10.1016/j.artres.2016.02.004
Palmieri BJ, Petroianu A, Silva LC, Andrade LM, Alberti LR. Study of arterial pattern of 200 renal pedicle through angiotomography. Rev Col Bras Cir. 2011;38(2):116-121. PMID: 21710050 DOI: https://doi.org/10.1590/s0100-69912011000200009
Famurewa OC, Asaleye CM, Ibitoye BO, Ayoola OO, Aderibigbe AS, Badmus TA. Variations of renal vascular anatomy in a Nigerian population: A computerized tomography studys. Niger J Clin Pract. 2018;21(7):840-6. PMID: 29984713 DOI: https://doi.org/10.4103/njcp.njcp_237_17
Sampaio FJ, Passos MA. Renal arteries: Anatomic study for surgical and radiological practice. Surg Radiol Anat. 1992;14(2):113-7. PMID: 1641734 DOI: https://doi.org/10.1007/bf01794885
Kornafel O, Baran B, Pawlikowska I, Laszczyński P, Guziński M, Sasiadek M. Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography. Pol J Radiol. 2010;75(2):38-45. PMID: 22802775 PMCID: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3389861/
Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surg Radiol Anat. 2004;26(6):474-9. PMID: 15378279 DOI: https://doi.org/10.1007/s00276-004-0272-9
Shoja MM, Tubbs RS, Shakeri A, Loukas M, Ardalan MR, Khosroshahi HT, et al. Peri-hilar branching patterns and morphologies of the renal artery: a review and anatomical study. Surg Radiol Anat. 2008;30(5):375-82. PMID: 18368282 DOI: https://doi.org/10.1007/s00276-008-0342-5
Swarna, Agarwal Y, Jain S, Chawla AS. Renal vasculature: Spectrum of anatomical variations and the significance from a surgeon’s standpoint. Astrocyte. 2018;4:233-9.
Uflacker R. Abdominal aorta and branches. In: Uflacker R, editor. Atlas of vascular anatomy: an angiographic approach. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2006; 111- 222.
Falesch LA, Foley WD. Computed Tomograpy Angiography of the Renal Circulation. Radiol Clin of North Am. 2016;51(1):71-86. PMID: 26654392 DOI: https://doi.org/10.1016/j.rcl.2015.08.003
Çlnar C, Türkvatan A. Prevalence of renal vascular variations: Evaluation with MDCT angiography. Diagnostic and Interventional Imaging. 2016;97(9):891-7. DOI: https://doi.org/10.1016/j.diii.2016.04.001
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