Descripción anatómica de la arteria polar renal accesoria y su relación con la hipertensión arterial / Anatomical description of accessory renal polar artery and its relationship with arterial hypertension

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.

Variantes anatómicas de origen de los ramos viscerales de la arteria aorta descendente infradiafragmática / Anatomical variants of the origin of the infra-diaphragmatic descendent aorta artery visceral branches

Introducción: la arteria aorta es el mayor de los vasos elásticos del cuerpo humano. Las variantes a la norma anatómica de los ramos arteriales son formaciones que deben ser reconocidas por sus implicaciones durante las cirugías. Objetivo: determinar las variantes de origen a la norma anatómica de los ramos viscerales de la arteria aorta infradiafragmática.Materiales y Métodos: se realizó un estudio observacional, descriptivo y prospectivo en 44 pacientes, mayores de 16 años, fallecidos por causas naturales en el Hospital Provincial Celia Sánchez, Manzanillo. Se observó, en el curso de la necropsia, el origen de los diferentes ramos viscerales de la arteria aorta infradiafragmática. Resultados: las variantes a la norma anatómica se constataron en el 45,45 % de los bloques predominando en el sexo femenino (59,09 por ciento). Las arterias renales fueron las que más variantes a la norma anatómica presentaron, con el 57,69 por ciento del total. En las arterias suprarrenales medias y gonadales se encontraron el 19,23 por ciento del total de variantes. El tronco celiaco fue el único ramo visceral impar en el que se constataron variantes a la norma anatómica (11,54 por ciento). El 11,54 por ciento de las variantes se corresponden con bifurcaciones anómalas de la arteria aorta. Conclusiones: las variantes de origen a la norma anatómica, de los ramos viscerales de la arteria aorta infradiafragmática, tienen una frecuencia alta. Las mayores variantes se localizan en las arterias renales no encontrando variantes en las arterias mesentéricas. El conocimiento de estas variantes es importante en procedimientos quirúrgicos(AU)

Background: aorta artery is the biggest of the human body elastic vases. The variants of the arterial branches anatomic norm are formations that should be recognized, because of their implications during surgeries. Aim: to determine the origin variants to the anatomic norm of the infra-diaphragmatic aorta artery visceral branches. Materials and Methods: an observational, descriptive, prospective study was carried out in 44 patients, elder than 16 years old, who died due to natural causes in the Provincial Hospital Celia Sanchez, Manzanillo. The origin of the different infra-diaphragmatic aorta artery visceral branches was observed in the course of the necropsy. Outcomes: variants to anatomic norm were stated in 45.45 percent of the blocks, predominating in the female gender (59.09 percent). Renal arteries were the ones presenting more variants to anatomic norm, with 57.69 percent of the total. 19.23 percent of the total of variants was found in the medial suprarenal and gonadal arteries. The celiac trunk was the only odd visceral branch where variants to anatomic branches were found (11.54 percent). 11.54 percent of the variants correspond to aorta artery anomalous bifurcations. Conclusions: the origin variants to anatomic norm of the infra-diaphragmatic aorta artery visceral branches have a high frequency. The biggest variants are located in the renal arteries. Variants were not found in the mesenteric arteries. These variants knowledge is important in surgical procedures(AU)

Hand-assisted Laparoscopic Nephrectomy in Living-donor Kidneys With Multiple Arteries: Experience of a Transplant Center.

OBJECTIVES: Hand-assisted laparoscopic nephrectomy is a relatively new procedure in our country. This article reports on one of the largest number of this procedure in kidneys with multiple vessels. MATERIALS AND METHODS: We reviewed all cases of hand-assisted laparoscopic nephrectomy from July 2002 to February 2009. Results were then descriptive, with statistical analyses performed with SPSS software (SPSS: An IBM Company, version 10.0, IBM Corporation, Armonk, NY, USA). RESULTS: From July 2002 to February 2009, 165 patients had hand-assisted laparoscopic nephrectomy, with 96.9% being the left kidney. We found a prevalence of 18.7% (n = 31) of kidneys with multiple arteries, with 8 of these having multiple principal arteries, 9 with superior polar artery, and 14 with inferior polar artery. Twenty-nine donors (17.57%) presented with more than 1 principal vein. Warm ischemia was longer in kidneys with multiple arteries (4.16 vs 3.96 min); recipient renal function (evaluated by creatinine levels at day 5 after transplant) was 1.63 mg/dL in kidneys with single artery versus 1.27 mg/dL in kidneys with multiple arteries. There were no significant differences for time of surgery, bleeding, and discharge of the donor. CONCLUSIONS: We found no differences in kidney function between single and multiple artery kidneys, resulting in the conclusion that hand-assisted laparoscopic nephrectomy offers an effective option for kidney donors, including those with multiple arteries.

Accessory (multiple) renal arteries - Differences in frequency according to population, visualizing techniques and stage of morphological development.

The aim of this paper is to comprehensively analyze the literature focused on frequency of the presence of the accessory renal arteries in the human body. A systematic analysis of papers has been made. With regard to ethnicity, the incidence of accessory renal arteries fluctuates from 4% in a Malaysian population to 61.5% in a Brazilian population. The frequency is lowest in eastern and southern Asia (from 4% to 18.4%). In some, not ethnically homogenous populations, wide span of occurrence of accessory renal arteries is described (e.g. American - averaging from 18% to 28.8%). A higher frequency of accessory renal arteries was observed in fetuses compared to adults. Moreover, differences in the presence and number of accessory renal arteries reported in different papers are a consequence of type of visualizing technique used in research - especially when computed tomography and anatomical dissection were compared. The increasing number of surgical interventions, especially where laparoscopic methods are concerned, underlines the importance of such knowledge especially to surgeons, interventional radiologists, nephrologists, and vascular surgeons.

Variaciones vasculares en cavidad abdominal y de vías urinarias: presentación de caso / Vascular variations in urinary tract and abdominal cavity: case report

Se presenta un raro caso de múltiples variaciones en la cavidad abdominal de un espécimen cadavérico de 50 años de género masculino, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga-Colombia). Se observó variaciones arteriales (arteria renal adicional derecha y origen de la rama hepática derecha desde la arteria mesentérica superior), venosa (vena renal derecha adicional) y de vía urinaria (doble uréter en el lado derecho). Estas diversas variantes anatómicas además de suscitar interés académico, deben ser consideradas y descritas correctamente por los clínicos durante la realización de procedimientos quirúrgicos, radiológicos y de imágenes diagnósticas en la cavidad abdominal.

Here we present a rare case of multiple abdominal cavity variations in a 50-year-old male cadaveric specimen of the anatomy laboratory of the Universidad Industrial de Santander (Bucaramanga, Colombia). The anatomical dissection revealed arterial variations (right additional renal artery and origin of the right hepatic branch from the superior mesenteric artery), venous (right additional renal vein) and urinary tract (duplicated ureter on the right side). These multiple anatomic variations in addition to raising academic interest, should be considered and described correctly by clinicians while performing surgical, radiological and imaging procedures in the abdominal cavity.

Multiple left renal artery in mongrel cat: case report / Artéria renal esquerda múltipla em gato sem raça definida: relato de caso

Knowledge of the renal vessels variations has importance in a systematization program of radiological and surgical anatomy, both in humans and animals, applied for research and surgical training. Particular attention has been paid to the study of these vessels, outlining the numerical variations noticed among various animal species. As a rule, the right artery arises more cranially than the left one, according with the most cranial position of the right kidney. Thus, the goal of this article is to describe a case of a left multiplicity renal artery originating from the ventral portion of the aorta, in a adult mongrel male cat cadaver, formalin-preserved at 10% and with colored Petrolátex vascular injection. The left kidney has multiple renal arteries. A cranial and caudal. The cranial artery emerged ventrally from the abdominal aorta as single vessel and issued the adrenal, lumbar branches and divided into two branches: one branch to the cranial end of the kidney and the other to the lateral edge of the kidney. The second caudal renal artery emerged ventrally from the abdominal aorta as single vessel and issued two renal arteries, a dorsal and ventral both directed to the renal hilum

O conhecimento das variações nos vasos renais possui importância em um programa de sistematização da anatomia radiológica e cirúrgica, tanto para o homem quanto para animais destinados a pesquisa, ensino e treinamento cirúrgico. Atenção particular é dada ao estudo desses vasos enfatizando as variações numéricas entre as diferentes espécies animais. A artéria renal direita se origina mais cranialmente que a esquerda de acordo com a posição mais cranial do rim direito. O objetivo deste relato é descrever um caso de artéria renal esquerda múltipla originando-se da superfície ventral da artéria aorta abdominal em um cadáver de gato SRD macho adulto. O mesmo foi fixado e preservado com solução de formaldeído a 10% e teve o seu sistema arterial preenchido com Petrolátex corado. O rim esquerdo apresentou artérias renais múltiplas, uma cranial e outra caudal. A primeira se originou ventralmente à aorta abdominal de forma única, emitiu ramos para a glândula adrenal, ramo lombar e bifurcou em 2 ramos : um ramo que penetrou diretamente na extremidade cranial do rim; o segundo ramo contornou a extremidade cranial do rim e penetrou na margem lateral do rim. A segunda artéria renal emergiu ventralmente à aorta abdominal de forma única e se bifurcou em duas artérias renais, uma dorsal e outra ventral ambas direcionadas ao hilo renal

Multiple left renal artery in mongrel cat: case report / Artéria renal esquerda múltipla em gato sem raça definida: relato de caso

Knowledge of the renal vessels variations has importance in a systematization program of radiological and surgical anatomy, both in humans and animals, applied for research and surgical training. Particular attention has been paid to the study of these vessels, outlining the numerical variations noticed among various animal species. As a rule, the right artery arises more cranially than the left one, according with the most cranial position of the right kidney. Thus, the goal of this article is to describe a case of a left multiplicity renal artery originating from the ventral portion of the aorta, in a adult mongrel male cat cadaver, formalin-preserved at 10% and with colored Petrolátex vascular injection. The left kidney has multiple renal arteries. A cranial and caudal. The cranial artery emerged ventrally from the abdominal aorta as single vessel and issued the adrenal, lumbar branches and divided into two branches: one branch to the cranial end of the kidney and the other to the lateral edge of the kidney. The second caudal renal artery emerged ventrally from the abdominal aorta as single vessel and issued two renal arteries, a dorsal and ventral both directed to the renal hilum(AU)

O conhecimento das variações nos vasos renais possui importância em um programa de sistematização da anatomia radiológica e cirúrgica, tanto para o homem quanto para animais destinados a pesquisa, ensino e treinamento cirúrgico. Atenção particular é dada ao estudo desses vasos enfatizando as variações numéricas entre as diferentes espécies animais. A artéria renal direita se origina mais cranialmente que a esquerda de acordo com a posição mais cranial do rim direito. O objetivo deste relato é descrever um caso de artéria renal esquerda múltipla originando-se da superfície ventral da artéria aorta abdominal em um cadáver de gato SRD macho adulto. O mesmo foi fixado e preservado com solução de formaldeído a 10% e teve o seu sistema arterial preenchido com Petrolátex corado. O rim esquerdo apresentou artérias renais múltiplas, uma cranial e outra caudal. A primeira se originou ventralmente à aorta abdominal de forma única, emitiu ramos para a glândula adrenal, ramo lombar e bifurcou em 2 ramos : um ramo que penetrou diretamente na extremidade cranial do rim; o segundo ramo contornou a extremidade cranial do rim e penetrou na margem lateral do rim. A segunda artéria renal emergiu ventralmente à aorta abdominal de forma única e se bifurcou em duas artérias renais, uma dorsal e outra ventral ambas direcionadas ao hilo renal(AU)

Safety and Clinical Outcome of the Delivery of Radiofrequency Nerve Ablation Therapy in a Renal Artery of Unusual Anatomy.

INTRODUCTION: Catheter-based renal sympathetic denervation is an emerging therapy for resistant hypertension (RHTN) patients, resulting in a significant blood pressure reduction. The presence of accessory renal arteries and anomalous branching patterns are reported in approximately 20-27 % of patients. However, accessory renal arteries, when smaller than 4 mm in diameter, they are out of the inclusion criteria for renal denervation therapy. For this reason patients with evidence of accessory renal arteries have been excluded in previous clinical trials. Recent data suggest that accessory renal arteries may play an important role in non-response therapy when they do not receive renal denervation treatment. CASE REPORT: In this report, we present the outcome of a patient with resistant hypertension and an anomalous right renal artery, having undergone denervation of both principal and accessory renal arteries. The renal ablation by radiofrequency energy of a distant accessory renal artery resulted in a safe procedure with no clinical complications. CONCLUSION: Consistent with literature the RDN of all, main and accessory renal arteries, was effective in decreasing patient blood pressure while decreasing the need for antihypertensive medication.

Irrigación renal: multiplicidad de arterias / Renal irrigation: multiplicity of arteries

Generalmente, el riñón consta de una arteria renal originada en la aorta abdominal, que luego se divide en una rama anterior y posterior, sin embargo no es raro encontrar más de una emergiendo de la parte abdominal de la aorta o de alguna arteria ilíaca. El incremento en el uso de la nefrectomía laparoscópica ha llevado a la necesidad de un conocimiento detallado de la anatomía vascular renal. Por la importancia de las variaciones arteriales renales, se presenta una disposición de irrigación múltiple, que fue observada en un individuo adulto de 54 años de edad y de sexo masculino, a través de una tomografía computarizada multidetectores, con reconstrucción tridimensional. En el lado derecho, se observaron cuatro arterias renales (AR), con origen independiente desde la parte abdominal de la aorta, donde la AR1 y AR4 ingresan en la parte inferior del seno renal y la AR2 y AR3 en la parte superior del mismo. En el lado izquierdo, se observaron dos arterias renales, donde la más superior (AR1) es la de mayor calibre. Casos con más de tres arterias son raros, de tal modo que la variación presentada en este artículo es de interés anatómico y clínico, por la presencia de cuatro arterias en el lado derecho y de dos en el lado izquierdo en un mismo individuo.

Generally, the kidney has a one renal artery originating from the abdominal aorta, which is then divided into an anterior and posterior branches, however not uncommon to find more than one emerging from the abdominal aorta or iliac artery some. The increased use of laparoscopic nephrectomy has led to the need for detailed knowledge of renal vascular anatomy. Given the importance of the renal artery variations, we present a multiple irrigation of the kidney, which was observed in an adult man of 54 years old, through multidetector computed tomography with three-dimensional reconstruction. On the right side, there were four renal arteries (RA), with an independent origin from the abdominal aorta, where RA1 and RA4 entering the bottom of the renal sinus and RA3 and RA2 at the superior part of this sinus. On the left, we observed two renal arteries where the most superior (RA1) is the largest size. Cases with more of three arteries are rare, so that the variation presented in this article had anatomical and clinical interest for the presence of four arteries on the right side and two on the left side in an individual.

Frequency of multiple renal arteries in human fetuses.

PURPOSE: The aim of the present study was to determine the frequency of occurrence of multiple renal arteries in human fetuses. METHODS: Sixty kidneys from human fetuses (32 males and 28 females) were used, fixed and kept in 10% formol solution. The fetal age was estimated from the hallux-calcaneus length and ranged from 20 to 37 weeks of gestation, with a mean of 25.63 weeks. The renal arteries were dissected without the aid of optical instruments, and their number, length, topographical layout in relation to their origins in the aorta walls and distribution according to gender and kidney (left or right) were determined. RESULTS: Out of the 60 kidneys investigated, 78.33% had a single renal artery and 21.67% had multiple renal arteries. Most of the renal arteries emerged from the lateral wall of the aorta between the levels of the lower third of the twelfth thoracic vertebra and the upper third of the first lumbar vertebra. The length ranged from 0.15 to 1.5 cm and was slightly greater in females. CONCLUSIONS: The frequency of findings of multiple renal arteries was 21.67%.

Doppler de arterias renales: parte 3 / Renal artery doppler: part 3

En esta última parte del artículo se describe el uso de doppler en patología venosa renal y trombosis venosa renal.

Study of arterial pattern of 200 renal pedicle through angiotomography.

OBJECTIVE: To investigate the prevalence and distribution of renal arteries and their branches in vivo, correlating the particularities found in them with sex and laterality. METHODS: Two hundred renal pedicles were studied by CT angiography and its arteries analyzed according to number, position of origin, size, length and trajectory in relation to renal segments. Its frequency and laterality were surveyed regarding gender and age. RESULTS: There were multiple arteries in 61.5% of the pedicles (56% in the right and 67% in the left), occurring in 65% of men and 58% of women. The aortic origin to the multiple arteries was more frequent on the right and, more often, the renal arteries originated between vertebrae L1 and L2 as pre-hilar division of the main artery. The average length of the main artery was higher in right kidneys with a single artery. There was no difference between the diameters of the main renal arteries. CONCLUSION: There is a higher prevalence of multiple renal arteries than the one described in the literature, with no difference for gender or laterality. The renal arteries originated more frequently between vertebrae L1 and L2, with divisions of the pre-hilar route and main artery to the hilum of the kidney. The average length of the main artery is greater on the right and in kidneys with single artery. There was no difference in diameter between the main renal artery between kidneys with single and multiple arteries.

Doppler de arterias renales: parte 2 / Renal artery doppler

En esta parte del artículo se describen la fisiopatología y etiología de la estenosis renal, así como metodología y técnicas para su idenficación por ultrasonido...

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias / Study of arterial pattern of 200 renal pedicle through angiotomography

OBJETIVO: Verificar a prevalência e a distribuição das artérias renais e de seus ramos in vivo, relacionando as particularidades encontradas nas artérias renais com o sexo e sua lateralidade. MÉTODO: Duzentos pedículos renais foram estudados por meio de angiotomografias e suas artérias analisadas de acordo com número, posição de origem, calibre, comprimento e trajeto em relação aos segmentos renais. Sua frequência e lateralidade foram pesquisadas quanto ao sexo e idade. RESULTADOS: Foram observadas múltiplas artérias em 61,5 por cento dos pedículos (56 por cento à direita e 67 por cento à esquerda), ocorrendo em 65 por cento dos homens e 58 por cento das mulheres. A origem aórtica para as múltiplas artérias foi mais frequente à direita e, com maior frequência, as artérias renais se originaram entre as vértebras L1 e L2 como divisões pré-hilares da artéria principal. O comprimento médio da artéria principal foi maior em rins direitos com artéria única. Não houve diferença entre o diâmetro da artéria renal principal. CONCLUSÃO: Existe maior prevalência das múltiplas artérias renais do que aquela descrita na literatura, sem diferença entre os sexos ou lateralidade. As artérias renais originaram-se com maior frequência entre as vértebras L1 e L2, como divisões pré-hilares da artéria principal e com trajeto ao hilo do rim. O comprimento médio da artéria principal é maior à direita e nos rins com artéria única. Não houve diferença no diâmetro da artéria renal principal entre rins com artérias únicas e múltiplas.

OBJECTIVE: To investigate the prevalence and distribution of renal arteries and their branches in vivo, correlating the particularities found in them with sex and laterality. METHODS: Two hundred renal pedicles were studied by CT angiography and its arteries analyzed according to number, position of origin, size, length and trajectory in relation to renal segments. Its frequency and laterality were surveyed regarding gender and age. RESULTS: There were multiple arteries in 61.5 percent of the pedicles (56 percent in the right and 67 percent in the left), occurring in 65 percent of men and 58 percent of women. The aortic origin to the multiple arteries was more frequent on the right and, more often, the renal arteries originated between vertebrae L1 and L2 as pre-hilar division of the main artery. The average length of the main artery was higher in right kidneys with a single artery. There was no difference between the diameters of the main renal arteries. CONCLUSION: There is a higher prevalence of multiple renal arteries than the one described in the literature, with no difference for gender or laterality. The renal arteries originated more frequently between vertebrae L1 and L2, with divisions of the pre-hilar route and main artery to the hilum of the kidney. The average length of the main artery is greater on the right and in kidneys with single artery. There was no difference in diameter between the main renal artery between kidneys with single and multiple arteries.

Doppler de arterias renales: parte 1 / Renal artery doppler: part 1

El doppler de arterias renales es una herramienta para valorar la presencia de estenosis en éstas arterias, de las que permite una evaluación anatómica completa. Se describen distintas técnicas de estudio, y aspectos anatómicos de las arterias.(AU)