Bilateral multiple renal arteries with an extra-aortic origin and quadruple testicular veins / 대한해부학회지

Spontaneous Renal Artery Dissection: An Important Differential Diagnosis for Sudden Onset of Back Pain / General Medicine

Spontaneous renal artery dissection (SRAD) is uncommon and hence diagnosis is often delayed when ideally a quick one is preferred. We report a case of a 53 year-old male, with a known history of nephrolithiasis, who was admitted into hospital complaining of sudden onset left-sided back pain. Ultrasound showed a right-sided calculus instead of the expected left. A subsequent contrast computed tomography (CT) scan was done showing an infarcted segment of the left kidney. Further investigation with angiography and intravascular ultrasound (IVUS) revealed the presence of two left renal arteries with the distal originating left renal artery having dissected.

Multiple Renal Artery Anastomosis in Kidney Transplantation: Clinical Outcome / 대한이식학회지

PURPOSE: Kidney transplantation with multiple renal arteries has been associated with higher incidence of vascular and urologic complications. Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively, so it would be clearly in the best interests to the recipients whether to include these individuals as organ donor candidates. There is an increasing requirement to use such kidneys and it is not unusual trend any more. Some authors insist the vessel anastomosis time (2nd warm ischemia time) exceeding 35 minutes may attribute to the development of acute tubular necrosis (ATN). There are various methods in anastomosis of multiple renal arteries but vascular and urologic complications depend on the technical surgical skills or methods of the vascular anastomosis. METHODS: A retrospective study was assessed for 454 kidney transplantations performed in the department of surgery, Maryknoll Medical Center between August, 1990, and May 2007. Study groups are divided into four groups according to anastomosis METHODS: Group I, a single-artery anastomosis (n=387) and others, multiple-artery anastomosis (Group II~Group IV) includes extracorporeal (Group II), intracorporeal (Group III) artery anastomosis, and polar artery ligation (Group IV). RESULTS: Among those groups, there are no significant differences in 2nd warm ischemia time, serum creatinine level, recipient and graft survival rate, acute tubular necrosis, acute rejection rate, blood pressure change, and urologic and vascular complication. CONCLUSION: Kidney transplantation of multiple renal arteries is not a difficult challenge any more and it is now more important to find out the better way and better result.

A Case of Multiple Renal Arteries Presented with the Manifestations of Renovascular Hypertension / 대한신장학회잡지

In 17-30% of subjects, at least one kidney is supplied by more than one artery arising from the aorta. Subjects with multiple renal arteries have been reported to suffer more frequently from hypertension, But the precise association between hypertension and multiple renal arteries was not yet defined. A 20- year old woman presented clinical manifestations of renovascular hypertension. Basal renin activity was elevated, and time-activity curves showed delayed peak time at captopril renal scan. Angiography showed multiple renal arteries with 2 right and left 3 arteries. There was neither stenosis nor inflammation. We strated angiotensin-receptor blocker, calcium channel blocker, and beta-blocker. The patient currently remains normotensive in an outpatient unit. In general, accessory renal arteries are narrower and longer than main artery. As a results, the renal segments supplied by accessory vessels might have lower levels of blood pressure than the remainder of the parenchyma, thereby increasing the renin secretion. So hypertension associated with multiple renal arteries might be involved in renin-angiotensin-aldosterone system activation.

Clinical Outcome of Renal Transplants with Multiple Renal Artery / 대한이식학회지

Kidney transplantation is the treatment of choice for the vast majority of patients with end-stage renal disease. A total of 350 living donor renal transplantations were performed by renal transplantation team of Dongsan medical center, Keimyung University between November 1982 and October 1996. In order to evaluate the results of renal transplantation using multiple renal arteries, we reviewed our recipients about their post-transplant renal function, blood pressure, rejection episode and complications according to their arterial anastomosing types. The recipients were divided into 4 groups: Group 1- one donor renal artery anastomosed to one recipient renal artery(n=288), Group 2- two donor renal arteries anastomosed to recipient renal artery as a single lumen(n=38) (2a; smaller renal artery anastomosed to larger renal artery as end to side fashion(n=23), 2b; double barrel type anastomosis after wedge shape excision of each renal artery(n=15)), Group 3-more than one donor renal arteries anastomosed to multiple sites of recipient arteries(n=9), Group 4-small polar artery was ligated(n=15). The BUN, serum creatinine, systolic and diastolic pressure all showed no statistical differences between each group at 1, 6 months and 1, 3, 5 years after transplantation. But the incidence of acute tubular necrosis was frequent in Group 4 compare with Group 1 (14.3% vs 1.4%) and their onset time is delayed than Group 1 (18.5 months vs 8.2 months). Acute rejection episode in Group 4 was also higher than other groups (80.0% vs 34.5%, 24%, 11.1% in group 1, 2, 3). Post-transplant surgical complication including urological complications, however, seems not correlated with type or number of renal artery anastomosis. These results suggest that number of renal artery of donor and renal arterial anastomosis in recipient didn't affect the post-transplant renal function and their clinical courses only if arterial anastomosis be done meticulously, but polar artery ligation must be avoided to reduce the incidence of acute tubular necrosis and acute rejection episode.

Clinical Outcome of Microsurgical Multiple Renal Artery Reconstruction in Renal Transplantation / 대한이식학회지

The incidence of multiple renal arteries has been reported as 18~30% in cadaveric organ procurement. There has been many cases in which the reconstruction of renal arteries were needed because of the use of donor kidney with multiple renal arteries or the injuries of renal arteries during organ harvest. We studied on the graft function and survival following reconstruction of multiple renal arteries. Between January 1990 and December 1996, we have performed 500 renal transplants, among which 65 cases(13%) of the multiple donor renal arteries were encountered either from the multiple number of donor renal artery itself or from the injury of renal artery during harvest. The remaining 435 cases had a single donor renal artery. The type of reconstruction under the microscope and graft material that we have used were illustrated as follows; ligation of a polar artery or two polar arteries in 8 cases, end to side anastomosis between a polar artery and main renal artery in 26 cases, side to side anastomosis between a polar artery and main renal artery in 12 cases, separate anastomosis of two renal arteries to external iliac or internal iliac artery in 2 cases, side to side anastomosis between two polar arteries then end to side anastomosis between reconstructed polar artery and a main renal artery in 3 cases, Carrel aortic patch in 3 cases, and interposition graft in 10 cases using inferior epigastric artery in 6 cases, branched internal iliac artery in 3 cases, and saphenous vein in 1 case. In the kidneys with reconstructed multiple renal arteries, the rate of vascular and urologic complications such as bleeding, stenosis, thrombosis of anastomotic site, ureteral obstruction and urinary leakage did not show any difference with the single renal artery group. And there was no difference in 1-year graft survival between the two groups. We think that the donor kidney with reconstructed multiple renal arteries does not have any negative impact on graft survival resulting in same early and late vascular and urologic complications as a single renal artery group when proper revascularization can be performed.

Living Donors with Multiple Renal Arteries in 100 Cases of Renal Transplantation / 대한비뇨기과학회지

One hundred kidney transplantations have been performed between November 1982 and July 1989. Twenty-seven patients received kidneys from living donors with multiple renal arteries. In eighteen patients both vessels were anastomosed, and in nine patients: a tiny polar vessel was sacrificed resulting in a small infarct in the grafted kidney. Results of transplantation in these patients were compared to those of recipients with or without infarcted kidney in regard to time, sex and age. Results using kidneys with anastomosed double renal arteries without infarct were almost as successful as those from a living donor with single renal arteries( well function kidney, serum creatinine <2.0mg/dl:70%). In contrast, recipients of kidneys with polar infarcts appear to have undergone more episodes of acute tubular necrosis, hypertension, or both(well function kidney :25%). Therefore, living donor with bilateral double renal arteries should be regarded as acceptable donor if both vessels can easily be anastomosed. If, however, a polar vessel has to be sacrificed. it is suggested that related living donor with polar artery should be excluded.