Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 1353 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
CASE REPORT Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 468-470
Bilateral triple renal arteries


1 Department of Anatomy, Cerrahpasa Medical Faculty of Istanbul University, Istanbul, Turkey
2 Department of Anatomy, Medical Faculty of Gaziantep University, Gaziantep, Turkey

Click here for correspondence address and email
 

   Abstract 

Knowledge of the variations of the renal artery has grown in importance with increa­sing numbers of renal transplants, vascular reconstructions and various surgical and radio logic tech­niques being performed in recent years. We report the presence of bilateral triple renal arteries, dis­covered on routine dissection of a male cadaver. On the right side, one additional renal artery ori­ginated from the abdominal aorta (distributed to superior pole of the kidney) and one other ori­ginated from the right common iliac artery (distributed to lower pole of the kidney). On the left side, both additional renal arteries originated from the abdominal aorta. Our observation has been com­pared with variations described in the literature and their clinical importance has been emphasized.

Keywords: Renal artery abnormalities, Triple renal arteries, Bilateral

How to cite this article:
Pestemalci T, Mavi A, Yildiz YZ, Yildirim M, Gumusburun E. Bilateral triple renal arteries. Saudi J Kidney Dis Transpl 2009;20:468-70

How to cite this URL:
Pestemalci T, Mavi A, Yildiz YZ, Yildirim M, Gumusburun E. Bilateral triple renal arteries. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2019 Jul 21];20:468-70. Available from: http://www.sjkdt.org/text.asp?2009/20/3/468/50782

   Introduction Top


Variations in the number of renal arteries are common, with the reported frequency ranging between 9 and 76%. [1] The number of additional arteries observed most frequently is one. In re­lated literature, additional renal arteries (ARAs) have been variously described as: anomalous, abnormal, accessory, aberrant, supernumerary, supplementary, multiple and polar. Knowledge of the variations of the renal vascular anatomy has grown in importance with the increasing numbers of renal transplants, vascular recons­tructions, and various surgical and radiologic techniques being performed in recent years.


   Case Report Top


During dissection of a 47 year old male cadaver, bilateral triple renal arteries were noticed. On the right side, the main renal artery arose from the abdominal aorta; the first additional renal artery (ARA), supplying the upper pole of the kidney, arose from the abdominal aorta and the second ARA, supplying the lower pole of the kidney, arose from the ipsilateral common iliac artery [Figure 1]. On the left side, the main renal artery and the ARAs (to upper and lower poles of the kidney) arose from the abdominal aorta [Figure 1].

On the right side, the first ARA (upper) was 4 mm in diameter and 5 cm in length, and origi­nated from the aorta anterolaterally. It had a downward course and passed behind the infe­rior vena cava. It then divided into multiple branches before entering the superior pole of the kidney. The right main renal artery, 4 mm in diameter, originated from the aorta anterola­terally and coursed transversely to the hilum of the kidney. The right main renal artery and the second ARA (lower) were located in front of the inferior vena cava and passed behind the ureter. The second ARA originated from the right common iliac artery, 1.7 cm below bifur­cation of the aorta. It was 3 mm in diameter and 5 cm in length.

On the left side, the ARAs originated from the abdominal aorta anterolaterally. The first ARA originated above and the second ARA origi­nated below the main renal artery. The first ARA had an obliquely downward course and divided into multiple branches before entering the hi­lum of the kidney. One of its branches passed infront of the main renal artery. The main renal artery originated from the abdominal aorta at the same level as the origin of the right renal artery. It was 3 mm in diameter. The second ARA originated from the abdominal aorta, between the first ARA and the left main renal artery. It had an obliquely downward course to the in­ferior pole of kidney. It passed in front of the left main renal artery and left ureter before en­tering the inferior pole of kidney.

The right and left kidneys, the ureters and renal veins were normal.


   Discussion Top


Bergman et al [2] reported that doubled renal arteries occur in about 10% of cases (based on 10,967 kidneys studied) and the incidence of the triple renal arteries is usually 1-2%. Khama­narong et al [3] dissected 267 cadavers (534 kid­neys) for establishing the incidence and charac­teristics of variations in renal arteries among Thai nationals. They found double renal arteries in 93 kidneys (17.43%) and triple renal arteries in five (0.93%). Bordei et al [4] analyzed 272 kid­neys for a study of renal vascularization and identified 54 (20%) double renal arteries and three (1.1%) triple renal arteries. Satyapal et al [1] studied 440 kidneys and reported that the inci­dence of a single ARA was 23.2% (102 kid­neys), and the incidence of a second ARA (tri­ple renal artery) was 4.5% (20 kidneys). The renal arteries of 140 human fetuses were studied which showed single additional renal artery in 19.2% and second additional renal artery in 2.1%. [5] Merklin and Michels, [6] who reviewed 11,000 necropsy studies, reported that triple renal ar­teries were found in 70 cases (0.6%). Satyapal and colleagues [1] mentioned that sometimes cases may be seen with more than two additional renal arteries; however, there are very few such cases reported in literature. [7],[8] Goscick et al [5] observed triple accessory renal arteries in 0.7% of 140 human fetuses.

Additional arteries were more frequently uni­lateral and rarely bilateral. Sampaio and Passos [9] studied 266 kidneys from 133 adult subjects and found bilateral variations in number of renal arteries in only 12 cases (4.5%). In the literature, reports from other authors indicates the follo­wing: Bordei et al, [4] among 272 kidneys, found 11% (6 samples) with bilateral anomalies; Sa­tyapal et al, [1] among 440 kidneys, described 10.2% of the cases having bilateral additional arteries. In these reports, the cases had one ARA or uni­lateral two ARAs. In our case, we noticed two ARAs bilaterally.

There are different reports in the literature on the presence of ARAs on the right or left sides. Satyapal et al [1] and Bordei [4] described a higher incidence of additional renal arteries on the left as compared to Goscicka et al [5] and Khamana­rong et al [3] who suggested a higher frequency on the right side. On the other hand, Sampaio and Passos [9] did not observe any statistically signifi­cant difference between the two sides.

The distance between the origin, from the aorta, of the double renal arteries was highly variable, with an average ranging between 1-2 mm and 4-6 cm. [1],[4] In our case, the ARAs were 5 cm in length, which is similar to available reports. The length of the main renal artery and ARAs is crucial for safe ligation in the living donor as well as to perform anastomosis without stricture in the recipient. [9]

The reported diameter of the ARA was 0.3-0.4 cm. [1] In the present case, the diameters of the ARAs were 0.3 and 0.4 cm. On the right side, the first ARA was equal in size to the right main renal artery, while the second ARA was smaller. On the left side, the first ARA was larger than the left main renal artery while the second was smaller.

In our case, we found bilateral triple renal ar­teries; this case was similar to one other case re­ported in literatures. This case was also of Tur­kish origin [10] raising the possibility that the pre­sence of ARAs may have an association with ethnic origin. It has been reported that there are differences in the incidence of ARAs according to ethnic origin (African, 37.1%; Indian, 17.4%; Caucasian, 35.3%; and "Colored" 18.5%. [1]

An awareness of renal vascular variations is important for both surgeons and radiologists. Knowledge of the variations in renal arterial supply has assumed increased importance for renal transplantation, the implantation of vascular stents, assessment of renovascular hyper­tension, vascular reconstruction, and reconstructive surgery for abdominal aortic aneurysms.

 
   References Top

1.Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kaliden JM. Additional renal arteries: Incidence and morphometry. Surg Radiol Anat 2001;23(1):33-8.  Back to cited text no. 1    
2.Bergman RA, Afifi AK, Miyauchi R. Renal arteries: Illustrated encyclopedia of human ana­tomic variation: Opus II: Cardiovascular system: Arteries: Abdomen. 2005. Available from: micVariants/Cardiovascular/Text/Arteries/Renal. html.  Back to cited text no. 2    
3.Khamanarong K, Prachaney P, Utraravichien A, Tongun T , Sripaoraya K. Anatomy of renal arterial supply. Clin Anat 2004;17(4):334-6.  Back to cited text no. 3    
4.Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surg Radiol Anat 2004;26(6):474-9.  Back to cited text no. 4    
5.Goscicka D, Szpinda M, Kochan J. Accessory kidney arteries in human fetuses. Ann Anat 1996;178(6):559-63.  Back to cited text no. 5    
6.Merklin RJ, Michels NA. The variant renal and suprarenal blood supply with data on the inferior phrenic, urethral and gonodal arteries. J Int Coll Surg 1958;29(1.1):41-76.  Back to cited text no. 6    
7.Gray GM. Multiple renal arteries. Anat Anz 1906;29:266-70. Cited by Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kaliden JM. Additional renal arteries: Inci-dence and morphometry. Surg Radiol Anat 2001;23(1):33-8.  Back to cited text no. 7    
8.Jeffery RF. Unusual origins of renal arteries. Radiology 1972;102:309-10. Cited by Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kaliden JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001;23(1):33-8.  Back to cited text no. 8  [PUBMED]  
9.Sampaio FJ, Passos MA. Renal arteries: Ana­tomic study for surgical and radiological prac-tice. Surg Radiol Anat 1992;14(2):113-7.  Back to cited text no. 9    
10.Bayazit M, Gol MK, Zorlutuna Y, Tasdemir O, Bayazit K. Bilateral triple renal arteries in a patient with iliac artery occlusion: A case report. Surg Radiol Anat 1992;14(1):81-3.  Back to cited text no. 10    

Top
Correspondence Address:
Ayfer Mavi
Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310 Gaziantep
Turkey
Login to access the Email id


PMID: 19414954

Rights and Permissions


    Figures

  [Figure 1]

This article has been cited by
1 Bilateral quadruple renal arteries
Miclaus, G.D. and Matusz, P.
Clinical Anatomy. 2012; 25(8): 973-976
[Pubmed]
2 Accessory renal vessels
Mohammed, A.M.A. and Abdalrasol, R.G.E. and Abdalhai, K.A. and Hamad, M.G.
Acta Informatica Medica. 2012; 20(3): 196-197
[Pubmed]
3 Variations of renal artery in 820 patients using 64-detector CT-angiography
Gümüş, H. and Bükte, Y. and Özdemir, E. and Çetinçakmak, M.G. and Tekbaş, G. and Ekici, F. and Önder, H. and Uyar, A.
Renal Failure. 2012; 34(3): 286-290
[Pubmed]
4 The abdominal aorta and its branches: Anatomical variations and clinical implications
Prakash, V.M. and Rajini, T. and Shashirekha, M.
Folia Morphologica. 2011; 70(4): 282-286
[Pubmed]
5 Variant anatomy of renal arteries in a Kenyan population
Ogengćo, J.A. and Masaki, C.O. and Sinkeet, S.R. and Muthoka, J.M. and Murunga, A.K.
Annals of Transplantation. 2010; 15(1): 40-45
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

 Article Access Statistics
    Viewed3045    
    Printed69    
    Emailed0    
    PDF Downloaded481    
    Comments [Add]    
    Cited by others 5    

Recommend this journal