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Burihan MC, Garbelotti SA, Cândido PL, de Souza RB, Pelozo O, Andrade A, De Angelis MA. Multiple variation of right renal and gonadal vascularization: report of two cases. J Vasc Bras 2024; 23:e20230044. [PMID: 38562126 PMCID: PMC10984585 DOI: 10.1590/1677-5449.202300442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.
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Affiliation(s)
- Marcelo Calil Burihan
- Hospital Santa Marcelina – HSM, São Paulo, SP, Brasil.
- Faculdade Santa Marcelina – FASM, São Paulo, SP, Brasil.
| | | | | | | | - Osvaldo Pelozo
- Faculdade Santa Marcelina – FASM, São Paulo, SP, Brasil.
| | - Aluisio Andrade
- Hospital Santa Marcelina – HSM, São Paulo, SP, Brasil.
- Faculdade Santa Marcelina – FASM, São Paulo, SP, Brasil.
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Borthakur D, Ansari MA, Rani N, Kumar R, Baxla M. A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects. J Vasc Bras 2024; 23:e20230120. [PMID: 38487514 PMCID: PMC10939177 DOI: 10.1590/1677-5449.202301202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 03/17/2024] Open
Abstract
Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.
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Affiliation(s)
| | | | - Neerja Rani
- All India Institute of Medical Sciences – AIIMS, New Delhi, India.
| | - Rajesh Kumar
- All India Institute of Medical Sciences – AIIMS, New Delhi, India.
| | - Monica Baxla
- All India Institute of Medical Sciences – AIIMS, New Delhi, India.
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Unilateral variations of inferior phrenic and suprarenal arteries: A case study with commentary on its clinical importance. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Anatomy of testicular artery: A proposal for a classification with MDCT angiography. Eur J Radiol 2021; 142:109885. [PMID: 34364047 DOI: 10.1016/j.ejrad.2021.109885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Knowledge of normal anatomy and variations of testicular arteries are critical for planning before minimally invasive surgery. In this article, we aimed to evaluate the morphological characteristics of testicular arteries by MDCT and propose a new classification system. METHOD A total of 400 adult patients (total of 819 testicular arteries) who underwent abdominal CT angiography examination for several unrelated reasons were enrolled in this study. Testicular arteries (TAs) were evaluated in terms of number, origin, course, and caliber. Based on our findings, we also proposed a novel anatomical classification for the TAs according to their origin (divided into 5 types-type 1-5-) and course (divided into three types-type a-c-). Type 4 origin and type a course are the expected normal origin and course of bilateral TAs. RESULTS The most common type based on the origin was type 4, with the testicular artery originating from the abdominal aorta, inferior to the level of the renal artery within 5 cm distal to the renal arteries. 70.7% of the right and 75.6% of the left testicular arteries were type 4. The most common type of the vessel course was the normal expected trajectory (type a) with an incidence of 76.3% for the right and 82.6% for the left testicular arteries. CONCLUSION Normal anatomy and variations of testicular arteries may be effectively evaluated by CT angiography in a non-invasive manner.
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Kim SH. Doppler US and CT Diagnosis of Nutcracker Syndrome. Korean J Radiol 2020; 20:1627-1637. [PMID: 31854150 PMCID: PMC6923211 DOI: 10.3348/kjr.2019.0084] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/17/2019] [Indexed: 12/23/2022] Open
Abstract
Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the LRV and hematuria. Doppler ultrasonography (US) has been commonly used for the diagnosis of NCS. However, several technical issues, such as Doppler angle and sample volume, need to be considered to obtain satisfactory results. In addition, morphologic changes of the LRV and a jetting phenomenon across the aortomesenteric portion of the LRV on contrast-enhanced computed tomography (CECT) are diagnostic clues of NCS. With proper Doppler US and CECT, NCS can be diagnosed noninvasively.
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Affiliation(s)
- Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Nallikuzhy TJ, Rajasekhar SSSN, Malik S, Tamgire DW, Johnson P, Aravindhan K. Variations of the testicular artery and vein: A meta-analysis with proposed classification. Clin Anat 2018; 31:854-869. [PMID: 29737575 DOI: 10.1002/ca.23204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/22/2018] [Accepted: 04/30/2018] [Indexed: 11/09/2022]
Abstract
Variations of testicular vessels are more common than supposed. The testicular artery varies because of abnormal regression of the lateral mesonephric arteries in the fetus, whereas variations in the testicular vein are due to abnormalities in the involution of the intersubcardinal anastomosis. Such variations are usually found incidentally during surgical procedures around the renal pedicle and they often lead to complications. Several authors have attempted to classify them. However, these attempts have not been comprehensive. Therefore, the aim of this study is to provide a simple yet comprehensive classification of variations of the testicular vessels. The PubMed database was searched using keywords pertaining to the testicular vessels. The results were subjected to the Anatomical Quality Assessment (AQUA) tool analysis and were screened for appropriateness for inclusion in this study. The screening procedure yielded 31 original articles, 83 case reports, and 1 review article. Both testicular arterial and venous variations were more common on the left side (20.73% and 24.61%) than the right (12.69% and 18.4%, respectively). We classified the testicular arteries on the basis of their number (N), site of origin (O), and course (C). Similarly, the testicular veins were classified on the basis of their number (N) and site of drainage (D). The proposed classification facilitates identification, understanding, and reporting of variations of the testicular vessels by radiologists. It will also help surgeons to enhance the quality of their treatment. Clin. Anat. 31:854-869, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Tom J Nallikuzhy
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - S S S N Rajasekhar
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - Sabin Malik
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - Dharmaraj W Tamgire
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - Phoebe Johnson
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - K Aravindhan
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
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Wadhwa A, Soni S. A study of Gonadal Arteries in 30 Adult Human cadavers. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2010. [DOI: 10.4137/cmrh.s3680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The gonadal arteries normally arise from the abdominal aorta. There are reports about the variant origin of these arteries. In the present study, we investigated the origin and course of the gonadal arteries and clinical implications of variant gonadal arteries are discussed. Out of 60 dissections, in 55 cases the gonadal artery was seen arising from abdominal aorta. In the remaining 5 cases, gonadal artery of renal origin was present in 3 cases, two on right and one on left side and of middle suprarenal origin was present in 2 cases on the left side. The present study agreed with the text book account i.e. right testicular artery passing anterior to inferior vena cava in majority of the cases i.e. 27 (90%). In the remaining 3 cases (10%), the right testicular artery was posterior to inferior vena cava. In our study, out of a total of 60 dissections, 57 dissections confirmed to type I pattern (95%). In 2 cases (3.3%) (11 M, 16 M) a type II pattern was seen on the right side. In 1 case (1.7%) (20 M), the left testicular artery arose directly from the aorta and arched over the renal vein giving a type III pattern. Awareness of variations of the testicular arteries such as those presented here becomes important during surgical procedures like varicocele and undescended testes. The variations described here are unique and provide significant information to surgeons dissecting the abdominal cavity.
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Affiliation(s)
- Ambica Wadhwa
- Department of Anatomy, Adesh Institute of Medical Sciences and Research, Bathinda
| | - Sandeep Soni
- Department of Chest and TB, Adesh Institute of Medical Sciences and Research, Bathinda
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Duplication of the inferior vena cava: anatomy, embryology and classification proposal. Anat Sci Int 2009; 85:56-60. [DOI: 10.1007/s12565-009-0036-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
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Mostafa T, Labib I, El-Khayat Y, El-Rahman El-Shahat A, Gadallah A. Human testicular arterial supply: gross anatomy, corrosion cast, and radiologic study. Fertil Steril 2008; 90:2226-30. [PMID: 18555239 DOI: 10.1016/j.fertnstert.2007.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 10/11/2007] [Accepted: 10/16/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To study human testicular arterial supply. DESIGN Prospective. SETTING Academic setting. PATIENT(S) Forty fresh male cadavers. INTERVENTION(S) Gross anatomy of 20 cadavers, corrosion casting of 10, and radiography of 10. MAIN OUTCOME MEASURE(S) Testicular vascular supply, course, branching, and anastomosis. RESULT(S) The testicular artery descends bilaterally in a straight course (85%) and in a convoluted course (15%). There were three sites of terminations: along the upper pole of the mediastinum testis (78.8%), giving terminal branches (16.2%) or descends without division (5%). Four patterns of termination were found, but in the majority (69.7%) it terminates as upper and lower polar branches. The cremasteric artery arises from the inferior epigastric artery and terminates close to the lower end of the testis, anastomosing with the lower polar branch of the testicular artery. The artery of the vas arises from the inferior vesical artery, terminates by several capsular branches close to the mediastinum testis, anastomosing with branches of the testicular artery along the mediastinum testis. CONCLUSION(S) The testis gets its arterial supply mainly from the testicular artery supplemented with the cremastric artery and the artery of the vas. The testis has rich vascular areas in the upper polar, mediastinum testis, and posterolateral segments.
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Affiliation(s)
- Taymour Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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