Résumé
Abstract The renal arteries arise from the lateral side of the abdominal aorta at the L2 vertebral level, just below the origin of the superior mesenteric artery. Multiple aberrant renal arteries can pose difficulties in renal transplantation, interventional radiological and urological procedures, renal artery embolization, angioplasty, or vascular reconstruction for congenital and acquired lesions. We present a case of a left kidney supplied by the left renal artery along with superior and inferior polar arteries, arising from the aorta and inferior mesenteric artery respectively. The inferior mesenteric artery was crossed by the left ureter and inferior mesenteric vein. The superior polar artery gave rise to an inferior suprarenal artery making the variation important for clinicians and surgeons.
Resumo As artérias renais originam-se do lado lateral da aorta abdominal, no nível da vértebra L2, logo abaixo da origem da artéria mesentérica superior. A presença de múltiplas artérias renais aberrantes pode representar dificuldades para transplante renal, procedimentos radiológicos e urológicos intervencionistas, embolização da artéria renal, angioplastia e reconstrução vascular para lesões congênitas e adquiridas. Apresentamos um caso de rim esquerdo vascularizado pela artéria renal esquerda e pelas artérias polares superior e inferior, as quais se originavam da aorta e da artéria mesentérica inferior, respectivamente. A artéria mesentérica inferior era cruzada pelo ureter esquerdo e pela veia mesentérica inferior. A artéria polar superior dava origem à artéria suprarrenal inferior, o que torna essa variação importante para clínicos e cirurgiões.
Résumé
La irrigación renal incluye la arteria renal y las arterias renales accesorias. Uno de estos vasos accesorios es la arteria polar renal superior o inferior. Estos vasos tienen un desarrollo embrionario y un origen anatómico similar a la arteria renal, tanto en la aorta abdominal como en sus ramas. Irrigan los segmentos renales correspondientes y se ha observado que su obliteración puede ser causa de aumento de la presión arterial, al estimular un aumento de renina circulante. El objetivo de este trabajo, es presentar un reporte de caso clínico de paciente masculino de 24 años, sin antecedentes mórbidos. Consulta por un cuadro de cefalea y mareos de 2 semanas de evolución. Clínicamente se pesquisó aumento de presión arterial y obesidad, sin fiebre ni otros hallazgos significativos. Los exámenes complementarios arrojan las siguientes alteraciones: triglicéridos (aumentados), presión arterial (aumentada), renina (aumentada) y AngioTac de abdomen evidenció una arteria renal polar accesoria superior izquierda, con estenosis vascular. La literatura indica que la hipertensión arterial esta correlacionada con la obstrucción parcial o total de una arteria renal o de una rama accesoria. Esta alteración en la disminución del flujo sanguíneo podría estimular la liberación de renina al torrente sanguíneo, afectando la presión arterial. Nuestros hallazgos concuerdan con lo descrito en la literatura y requieren ser considerados en el diagnóstico de hipertensión arterial. Este caso evidencia la necesidad de realizar una revisión exhaustiva de la base anatómica de la medicina con un enfoque integrativo, lo que permitirá mejorar el diagnóstico, el tratamiento y el pronóstico de patologías donde esta información es poco clara o inexistente.
The kidney irrigation includes the renal artery and the accessory renal arteries. One of these accessory vessels is the superior or inferior renal polar artery. These vessels have an embryonic development and an anatomical origin similar to the renal artery, both in the abdominal aorta but also of its branches. Irrigate the corresponding renal segments and it has been observed that their obliteration may cause increased blood pressure, by stimulating an increase in circulating renin. The objective of this work is to present a clinical case report of a 24year-old male patient, with no morbid history. Consultation due to headache and dizziness symptoms with 2 weeks of evolution. Clinically increased blood pressure and obesity, without fever or other significant findings. Corresponding exams showed the following changes: triglycerides (increased), blood pressure (increased), renin (increased) and abdominal AngioTac showed a left upper accessory polar renal artery with vascular stenosis. The literature indicates that arterial hypertension is correlated with partial or total obstruction of a renal artery or an accessory branch. This alteration in the decrease in blood flow could stimulate the release of renin into the bloodstream, affecting blood pressure. Our findings agree with what is described in the literature and need to be considered in the diagnosis of arterial hypertension. This case demonstrates the need for an exhaustive review of the anatomical basis of medicine with an integrative approach. This would improve diagnosis, treatment and prognosis of pathologies where this information is unclear or non-existent.
Sujets)
Humains , Mâle , Jeune adulte , Artère rénale/malformations , Hypertension artérielle , Artère rénale/imagerie diagnostiqueRésumé
In comparison with other organs, variants of blood supply to the kidneys were always at special attention due to end arteries. Anatomic variations in the renal vasculature are common and occurrence is varying in between 25% to 40%. The most common variation is presence of accessory renal arteries. Accessory renal artery generally diagnosed on abdomen angiography studies or cadaveric dissection. Only few studies or case report of intrauterine detection of accessory renal artery are available in printed and online literature. During a dedicated anomaly scan of 23 week foetus, detection of an accessory renal artery on left side entering kidney in inferior pole courses parallel to main renal arteries and arising from abdominal aorta. Knowledge of the possible anatomic variations and anomalies of the renal arteries like accessory renal arteries are necessary for proper surgical management during renal transplantation, abdominal aorta aneurysm repair, different urological procedures and angiographic procedures. As the various type of vascular and non - vascular interventions increase, knowledge of the different type of variations of the renal arteries is necessary for proper surgical management in the different specialties.
Résumé
Background: The diversity of the human body structure which results to a great variety of vascular branching,seems to be endless. The vascular variations of the renal arteries are among the most frequent discovered ones.We present such a case, found during an educational cadaveric dissection.Results: Vascular branching alternations from the norm were observed in both kidneys of the case report. Abilateral presence of additional arteries, a polar one in the right side and a hilar one in the left side, with adouble renal vein in the left side were observed.Conclusions: Anatomy of the renal vessels usually is depicted with a plethora of variants. Clinicians should beaware that the renal topographical anatomy presents such difficulties, in order for complications to be avoidedduring various procedures.
Résumé
Background: Variation in renal arteries are very common but bilateral variation is rare and is clinically importantfor urologist especially during the renal transplantation. Generally main renal artery divides into anterior andposterior branches just before entering the hilum of kidney, but sometimes two or more polar arteries; prehilarbranching and segmental arteries arise from main renal artery .Renal artery variations are often seen and aregenerally categorized into presence of accessory or aberrant renal arteries, polar arteries and prehilar branches.Prehilar multiple branching of main renal artery variation is frequently seen.Materials and Method: The present study was conducted in 80 kidneys from 40 cadavers during the routinedissection in the Department of Anatomy Maharishi Markandeshwar Medical College and Muzaffarnagar MedicalCollege .Out of 80 kidneys studied bilateral prehilar branching of renal arteries from the main renal artery wereobserved in 5 kidneys (6.5%).Conclusion: Different arterial branching patterns was observed in five cases in which prehilar branches originateddirectly from main renal artery, entering the upper pole of kidney. Knowledge of such variation is important forradiologists, anatomists and urologists while performing renal transplantation, laparoscopic renal surgeries,nephrectomies, and other renal surgeries and diagnosis.
Résumé
Introduction: Splenic artery was previously called as Lineal artery. Splenic artery is the largest branch of the celiac trunk and is the most tortuous artery in the body. Splenic artery mainly supplies spleen and gives off branches to the stomach and the pancreas. Splenic artery divides into terminal branches before entering into the hilum of the spleen which may be Magistral or Distributed type. Sometimes it may pass through the hilum without dividing and supplies the spleen. Materials and methods: The study was done on 50 embalmed cadavers during routine dissection practices for undergraduates in the dissection hall of Gandhi Medical College, Secunderabad, and from the Department of Anatomy Osmania medical college, Hyderabad, during the period of 3years.The variations in the branching pattern of the splenic artery was observed and photographed. The prime objective of the study is to compare the prevalence of variations in the branching pattern of splenic artery. Results and conclusion: The variations in the present study were almost correlated with the available literature. In some instances the left gastro epiploic artery, the posterior gastric artery and the accessory left gastric artery took origin from the interior of spleen. so care should be taken during splenectomy. Hence, the arterial blood supply of spleen is so varied that no two vascular patterns are ever the same.
Résumé
Renal artery variations are becoming more important due to the gradual increase in interventional radiological procedures, urological and vascular operations, and renal transplantation. In the present study out of 80kidneys 40(50%) kidneys showed the presence of additional renal arteries. The results are statistically significant. The presence of additional renal arteries was found unilaterally in 14 cadavers and bilaterally in 6 cadavers. In 10 kidneys additional artery towards the superior pole (Superior polar artery) was observed and in 10 kidneys inferior polar arteries were seen. And superior and inferior polar arteries both are present in 20 kidney specimens. In 40 kidney specimens we were found duplicated renal arteries. This multiple renal artery variations are of great clinical significance to radiologists, nephrologists and urologists in imaging and urological procedures.
Résumé
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.