Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries

Abstract

Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.

Keywords: accessory; anatomical variation; kidney; multiple; renal artery.

Figure 1

Structures of the retroperitoneal region Ao – abdominal aorta, RRA 1 – right additional superior hilar renal artery, RRA 2 – main right renal artery, RRA 3 – right additional inferior hilar renal artery, RRA 4 – right additional inferior polar renal artery, LRA 1 – left additional superior hilar renal artery, LRA 2 – main left renal artery, LRA 3 – left additional inferior polar renal artery, LRA 4 – left additional inferior polar renal artery, U – urether.

Figure 2

Three-dimensional computed tomography reconstruction of the arteries Ao – abdominal aorta, LRA – main left renal artery, RRA 1 – right additional superior polar renal artery, RRA 2 – right additional superior hilar renal artery, RRA 3 – main right renal artery.

Figure 3

Three-dimensional computed tomography reconstruction of the arteries Ao – abdominal aorta, RRA 1 – right additional superior hilar renal artery, RRA 2 – main right renal artery, LRA 1 – left additional superior polar renal artery, LRA 2 – main left renal artery, LRA 3 – left additional inferior hilar renal artery.

Figure 4

Posterior view of the kidneys and abdominal arteries on MDCT angiographies with 3D reconstruction Ao – abdominal aorta, LRA 1 – main left renal artery, LRA 2 – left additional inferior polar renal artery, RRA 1 – right additional superior hilar renal artery, RRA 2 – main right renal artery, RRA 3 – right additional inferior hilar renal artery.

Figure 5

Three-dimensional computed tomography reconstruction of the arteries Ao – abdominal aorta, IMA – inferior mesenteric artery, LRA 1 – main left renal artery, LRA 2 – left additional inferior hilar renal artery, RRA 1 – main right renal artery, RRA 2 – right additional inferior hilar renal artery.

Figure 6

Horseshoe kidney with abdominal arteries: A – anatomical dissection (posterior view), B – volume rendering technique (VRT) image (anterior view from MDCT angiographies with 3D reconstruction) Ao – abdominal aorta, ARA – additional renal artery (passing to the isthmus), LRA – main left renal artery, RRA – main right renal artery, U – ureter.