An undetected common renal arterial trunk: surgical consequences and morbidity analysis

There are more anatomical variants in heaven and earth, Horatio, than are dreamt of in our philosophy: the precaval left renal artery

AIM

To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA).

MATERIALS AND METHODS

We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Associated vascular and renal anomalies were noted.

RESULTS

No patient had been examined for problems related to the vascular anomaly found. Four had a double IVC and two a solitary left IVC; in all, the left-sided IVCs had hemiazygos continuation. One patient had situs viscerum inversus. In one case, there was a left kidney in left iliac fossa.

CONCLUSION

Although rare and probably overlooked, a pLRAs can be encountered in patients with situs viscerum inversus or presenting a left-sided IVC with hemiazygos continuation. These vessels can cause technical problems during surgery at the left renal hilum and should be specifically searched for in patients with vascular anomalies.

A Detailed Study of Multiple Vascular Variations in the Upper Part of Abdomen

Introduction:

Knowledge of vascular variations near the kidney is of importance to many clinical disciplines such as nephrologists, radiologists, gastroenterologists, and general surgeons. Variant branches of the abdominal aorta and renal arteries are the victims of iatrogenic bleeding during surgery. We found multiple vascular variations in the upper part of the abdomen during our dissection classes.

Methods:

During the dissection classes of the abdomen for undergraduate medical students, we observed multiple vascular variations in the abdomen of an adult male cadaver. The vessels and surrounding viscera were cleaned using dissection instruments. Variations observed were photographed.

Results:

The right kidney had its hilum directed posteriorly. There were two right renal veins and a partially doubled left renal vein (LRV). The left suprarenal and gonadal veins drained into the upper LRV. There were two right renal arteries. Upper right renal artery gave origin to the right inferior phrenic and middle suprarenal arteries. There were two renal arteries on the left side also. The left upper renal artery gave a polar branch to the left kidney and divided into two branches before entering the kidney. The left inferior phrenic artery (IPA) gave two gastric branches to the fundus of the stomach.

Conclusions:

The variations noted by us are of tremendous surgical application. The variant vessels might get damaged during surgical procedures if the surgeons are not aware of these variations. The most important among the variations reported here is the gastric branch of the IPA, which has not been reported yet.