Evaluation of Renal Vascular Variations in Routine Computed Tomography Examinations

Year 2021, Volume: 3 Issue: 3, 171 - 176, 01.09.2021

Ahmet Vural , Ahmet Kahraman

https://doi.org/10.37990/medr.942364

Abstract

Aim: Anatomical variations of the kidney, including multiple renal arteries are crucial for renal and abdominal aortic surgery and renovascular hypertension. In this study, we aimed to investigate the frequency of multiple renal arteries in a Turkish population by evaluating the images of patients who underwent contrast-enhanced computed tomography (CT) for various reasons.
Material and Methods: Images of patients who underwent contrast abdominal computed tomography in our hospital due to various health problems were evaluated retrospectively. The presence, number, and exit levels of multiple renal arteries were examined.
Results: In the study, CT scans of 470 patients, aged between 18 and 69 years (43.7 ± 14.1) were analyzed retrospectively. Of the 940 kidneys evaluated, 113 had multiple renal arteries. Of the multiple renal arteries, 59 belonged to women and 54 to men, and the difference was found to be statistically insignificant. The incidence of multiple renal arteries was determined as 20.6% in evaluated cases and 12% in evaluated kidneys. The number and frequency of occurrence is 53 (47%) in the right kidney and 60 (53%) in the left kidney, respectively, and there is no significant difference between the two sides. Accessory renal arteries originated from the abdominal aorta between lumbar 1 vertebra (L1) and L4, except for 2 cases where they originated from the iliac artery.
Conclusion: The incidence of multiple renal arteries in the Turkish population was found at rates similar to the literature, using CT. CT is found to be a reliable method in detecting multiple renal arteries. Considering the presence of multiple renal arteries in CT examinations, we think that valuable information can be obtained in the investigation of renovascular hypertension.

Keywords

Multiple renal arteries, anatomical variations, computed tomography, renal vasculature

Rutin bilgisayarlı tomografi incelemelerinde renal vasküler varyasyonların değerlendirilmesi

Abstract

Amaç: Çoklu renal arter varlığı böbrek ve abdominal aorta cerrahisinde, renovasküler hipertansiyonda önemli bir rol oynar. Çeşitli nedenlerle kontrastlı bilgisayarlı tomografi (BT) yapılmış hastaların görüntülerini değerlendirerek Türk toplumunda çoklu renal arter sıklığını araştırmayı amaçladık.
Gereç ve yöntem: Çeşitli sağlık problemleri nedeni ile hastanemizde kontrastlı abdominal bilgisayarlı tomografi yapılmış hastaların görüntüleri geriye dönük olarak değerlendirildi. Çoklu renal arter varlığı, sayısı ve çıkış düzeyleri incelendi.
Bulgular: Çalışmada 470 hastanın BT taraması retrospektif olarak incelendi. Olguların yaş ortalaması 43.7±14.1 olup yaş aralığı 18-69 idi. Değerlendirilen 940 böbreğin 113’ünde çoklu renal arter mevcuttu. Çoklu renal arterlerin 59’u kadın, 54’ü ise erkek olup cinsiyetler arasında anlamlı farklılık yoktu. Değerlendirilen olgularda çoklu renal arter görülme sıklığı %20.6, değerlendirilen böbrekler için ise %12 olarak belirlendi. Görülme sayı ve sıklığı sırası ile sağ böbrekte 53 (%47) ve sol böbrekte 60 (%53) olup iki taraf arasında anlamlı farklılık yoktu. Aksesuar renal arterler iliak arterden köken aldığı 2 vaka dışında lomber 1-4 vertebralar (L1-L4) arası abdominal aortadan köken almakta idi.
Sonuç: BT ile Türk toplumunda çoklu renal arter sıklığı literatür ile benzer oranlarda tespit edilmiştir. Çoklu renal arter tespitinde BT güvenilir bir yöntemdir. BT incelemelerinde çoklu renal arter varlığının dikkate alınması ile renovasküler hipertansiyon araştırılmasında ve cerrahi girişimler öncesinde değerli bilgiler edinilebileceğini düşünmekteyiz.

References

• 1. Williams PL, Dyson M. Gray’s Anatomy. 37th Edition. Churchill Livingstone London: 1995;1407-9,1557.
• 2.Moore KL, Dalley AF. Clinically Oriented Anatomy, 4th Edition, Williams & Wilkins, London; 1999;284-8.
• 3. Ichikawa T, Tanno K, Okochi T, et al. Evaluation of Renal Artery Anomalies Associated with Horseshoe Kidney Using CT Angiography. Tokai J Exp Clin Med. 2015;40:16-21.
• 4. Kari JA, Roebuck DJ, Tullus K. Renal artery stenosis in association with congenital anomalies of the kidney and urinary tract. Saudi Med J. 2014;35:1264-6.
• 5. Ozkan U, Oğuzkurt L, Tercan F, et al. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol. 2006;12:183-6.
• 6.Kadotani Y, Okamoto M, Akioka K, et al. Management and outcome of living kidney grafts with multiple arteries. Surg Today. 2005;35:459-66.
• 7. Makiyama K, Tanabe K, Ishida H, et al. Successful renovascular reconstruction for renal allografts with multiple renal arteries. Transplantation. 2003;75:828-32.
• 8. Nomura G, Kurasaki M, Kondo K, et al. Essential hypertension in multiple renal arteries. Am Heart J. 1971;81:274-80.
• 9. Kudo K, Abe K, Yasujima M, et al. Essential hypertension and multıple renal arteries. Nippon Naika Gakkai Zasshi 1987;76:796-801.
• 10. Secen O, Akbulut M, Harman M, et al. Frequency of Accessory renal artery in hypertensive patients. MN Cardiology. 2014;21:151-5.
• 11.. Oner S, Oner Z. Variations of arteria renalis: a study of multidedector CT angiography. Kafkas J Med Sci. 2019;9:1-5.
• 12. Prevljak S, Prelevic E, Mesic S, et al. Frequency of acccessory renal arteries diagnosed by computerized tomography. Acta Inform Med. 2017;25:175-7.
• 13. TM Sadler, Longman’s Medical Embriology. Philadelphia. 1997;260-269.
• 14. Seeley R.R, Stephens T.D, Tate P. Essentials of anatomy physiology, Wcb/McGraw-Hill. 1996;2:489-90.
• 15. Fırat A, Akın O, Ağıldere A.M, et al. Contrast-enhanced magnetic resonance angiography: evaluation of renal arteries in living renal transplant donors. Eur Radiol. 2004;52:84-93.
• 16. Fain SB, King BF, Breen JF, et al. High-spatial-resolution contrast-enhanced MR angiography of the renal arteries: a prospective comparison with digital subtraction angiography. Radiology. 2001;218:481-90.
• 17. Beregi J.P, Mauroy B, Willoteaux S, et al. Anatomic variation in the origin of the main renal arteries spiral CTA evaluation. Eur Radiol. 1999;9:1330-4.
• 18. Çiçekçibaşı A, Ziylan T, Salbacak A, et al. An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance. Ann Anat. 2005;187:421-7.
• 19. Khamanarong K, Prachaney P, Utraravichien A, et al. Anatomy of renal arterial supply. Clin Anat. 2004;17:334-6.
• 20. Satyapal KS, Haffejee AA, Singh B, et al. Additional renal arteries: incidence and morphometry. Surg Radiol Anat. 2001;23:33-8.
• 21. Sampaio FJ, Passos MA. Renal arteries: anatomic study for surgical and radiological practice. Surg Radiol Anat. 1992;14:113-7.
• 22. Baltacıoğlu F, Ekinci G, Akpınar IN, et al. Endovascular treatment of renal arter stenosis: technical and clinical results. Diagn Intervent Radiol. 2003;9:246-56.
• 23. Atasoyu EM, Evrenkaya TR, Ünver S, et al. Genç hipertansif erkek hastalarda multipl renal arter varlığı ile hipertansiyon iliskisi. Turkish J Nephrol. 2004;13:165-8.
• 24. Aytac SK, Yigit H, Sancak T, et al. Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation. J Ultrasound Med. 2003;22:433-9.
• 25. Sevinç Ö, Büken B, Gönül C, et al. The case of bilateral multiple renal arteries. Duzce Med J. 2002;4:23-5.
• 26. Bordei P, Şapte E, Iliescu D. Double Renal arteries originating from the aorta. Surg Radiol Anat. 2004;26:474–9.