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Multidetector computed tomography angiography study of the renal arterial vasculature anatomy and its variations in a Bulgarian adult population

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Abstract

Purpose

Renal arterial anatomy has a great clinical importance during surgical and endovascular procedures. However, comprehensive data on renal arterial variations in the Bulgarian population has not yet been provided. The aim of this study was to conduct a detailed research about the normal anatomy and variations of the renal arteries in the Bulgarian population.

Methods

Five hundred sixty-one patients underwent contrast-enhanced multidetector computed tomography scans for the period 2016–2021. The images were retrospectively reviewed. Number, branching pattern, origin level and course of the renal arteries were noted. Data were categorized on the basis of laterality, gender and symmetry.

Results

Only 46.3% of the patients exhibited normal renal arterial anatomy. Variations were observed in 301 patients (53.7%). The most common variant was the presence of accessory renal arteries (ARA), discovered in 41.2% of the subjects. There was no significant difference based on gender and laterality (p > 0.05). Hilar ARA (72.6%) were significantly more common than polar ARA (p < 0.001). The most common origin location of the main renal arteries and ARA was the aorta, followed by the common iliac arteries. Early division was observed in 21.7% of the patients, significantly more common on the right. Precaval course was found in 0.5% of the right main renal arteries and in 30% of ARA and the difference was significant (p < 0.001).

Conclusion

These results show novel insight into the prevalence of renal arterial variations in the Bulgarian population. Anatomic renal vasculature variants are common therefore awareness is crucial for the success of surgical and interventional procedures.

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Data availability

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References

  1. Arevalo Pérez J, Gragera Torres F, Marín Toribio A, Koren Fernández L, Hayoun C, Daimiel Naranjo I (2013) Angio CT assessment of anatomical variants in renal vasculature: its importance in the living donor. Insights Imaging 4:199–211. https://doi.org/10.1007/s13244-012-0217-5

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bouali O, Labarre D, Molinier F, Lopez R, Benouaich V, Lauwers F, Moscovici J (2012) Anatomic variations of the renal vessels: focus on the precaval right renal artery. Surg Radiol Anat 34:441–446. https://doi.org/10.1007/s00276-011-0923-6

    Article  PubMed  Google Scholar 

  3. Bouzouita A, Saadi A, Hermi A, Chakroun M, Bouchiba N, Allouche M, Hamdoun M, Mighri MM, Chebil M (2021) Cadaveric study of arterial renal anatomy and its surgical implications in partial nephrectomy. Surg Radiol Anat 43:1449–1459. https://doi.org/10.1007/s00276-021-02769-8

    Article  PubMed  Google Scholar 

  4. Cenal U, Erturk T, Karayagiz AH, Ozdemir E, Polatkan SV, Cakir U, Berber I (2019) Geographic distribution of multiple arteries and veins of 878 kidney donors from a transplant center in Turkey. Transplant Proc 51:1086–1088. https://doi.org/10.1016/j.transproceed.2019.01.100

    Article  CAS  PubMed  Google Scholar 

  5. Chiarenza SF, Bleve C, Fasoli L, Battaglino F, Bucci V, Novek S, Zolpi E (2016) Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients. J Pediatr Surg 51:310–314. https://doi.org/10.1016/j.jpedsurg.2015.10.005

    Article  PubMed  Google Scholar 

  6. Cicek SK, Ergun S, Akıncı O, Sarıyar M (2021) Renal vascular and ureteral anatomic variations in 1859 potential living renal donors. Transplant Proc 53:2153–2156. https://doi.org/10.1016/j.transproceed.2021.07.030

    Article  CAS  PubMed  Google Scholar 

  7. Çınar C, Türkvatan A (2016) Prevalence of renal vascular variations: evaluation with MDCT angiography. Diagn Interv Imaging 97:891–897. https://doi.org/10.1016/j.diii.2016.04.001

    Article  PubMed  Google Scholar 

  8. Famurewa OC, Asaleye CM, Ibitoye BO, Ayoola OO, Aderibigbe AS, Badmus TA (2018) Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys. Niger J Clin Pract 21:840–846

    CAS  PubMed  Google Scholar 

  9. Garcia LE, Parra N, Gaynor JJ, Baker L, Guerra G, Ciancio G (2021) Clinical outcomes following single vs. multiple vessel living-donor kidney transplantation: a retrospective comparison of 210 patients. Front Surg. https://doi.org/10.3389/fsurg.2021.693021

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gulas E, Wysiadecki G, Szymański J, Majos A, Stefańczyk L, Topol M, Polguj M (2015) Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci 14:442–453. https://doi.org/10.5114/aoms.2015.55203

    Article  Google Scholar 

  11. Gümüş H, Bükte Y, Ozdemir E, Cetinçakmak MG, Tekbaş G, Ekici F, Onder H, Uyar A (2012) Variations of renal artery in 820 patients using 64-detector CT-angiography. Ren Fail 34:286–290. https://doi.org/10.3109/0886022X.2011.647295

    Article  PubMed  Google Scholar 

  12. Hlaing KP, Das S, Sulaiman IM, Abd-Latiff A, Abd-Ghafar N, Suhaimi FH, Othman F (2010) Accessory renal vessels at the upper and lower pole of the kidney: a cadaveric study with clinical implications. Bratisl Lek Listy 111:308–310

    PubMed  Google Scholar 

  13. Hoffer FA, Lebowitz RL (1985) Intermittent hydronephrosis: a unique feature of ureteropelvic junction obstruction caused by a crossing renal vessel. Radiology 156:655–658. https://doi.org/10.1148/radiology.156.3.4023225

    Article  CAS  PubMed  Google Scholar 

  14. Johnson PB, Cawich SO, Shah SD, Aiken W, McGregor RG, Brown H, Gardner MT (2013) Accessory renal arteries in a Caribbean population: a computer tomography based study. Springer Plus. https://doi.org/10.1186/2193-1801-2-443

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kang K, Ma Y, Jia C, Cheng Y, Yang Y, Wang L, Jiang Y, Lu Y (2020) Relationship between accessory renal artery and clinical characteristics of middle-aged patients with primary hypertension. Int J Hypertens. https://doi.org/10.1155/2020/7109502

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kim J, Lee JM, Cho SG, Hong JU (2022) Ectopic vascularization of the right kidney arising from contralateral common iliac artery. Surg Radiol Anat 44:979–981. https://doi.org/10.1007/s00276-022-02970-3

    Article  PubMed  Google Scholar 

  17. Kuczera P, Włoszczyńska E, Adamczak M, Pencak P, Chudek J, Wiecek A (2009) Frequency of renal artery stenosis and variants of renal vascularization in hypertensive patients: analysis of 1550 angiographies in one centre. J Hum Hypertens 23:396–401. https://doi.org/10.1038/jhh.2008.149

    Article  CAS  PubMed  Google Scholar 

  18. Kumaresan M, Saikarthik J, Sangeetha A, Saraswathi I, Senthil Kumar K, Roselin P (2021) Peri-hilar branching pattern and variations of the renal artery among Indian kidney donors using pre-operative computed tomography angiography: an anatomical study and review. Folia Morphol (Warsz). https://doi.org/10.5603/FM.a2021.0103

    Article  PubMed  Google Scholar 

  19. Majos M, Polguj M, Szemraj-Rogucka Z, Arazińska A, Stefańczyk L (2018) The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study. Surg Radiol Anat 40:1185–1191. https://doi.org/10.1007/s00276-018-2071-8

    Article  PubMed  PubMed Central  Google Scholar 

  20. Natsis K, Paraskevas G, Panagouli E, Tsaraklis A, Lolis E, Piagkou M, Venieratos D (2014) A morphometric study of multiple renal arteries in Greek population and a systemic review. Rom J Morphol Embryol 55:1111–1122

    PubMed  Google Scholar 

  21. Palmieri J, Petroianu A, Silva LC, Andrade LM, Alberti LR (2011) Study of arterial pattern of 200 renal pedicle through angiotomography. Rev Col Bras Cir 38:116–121. https://doi.org/10.1590/s0100-69912011000200009

    Article  PubMed  Google Scholar 

  22. Regmi PR, Amatya I, Kayastha P, Paudel S, Suwal S, Ghimire RK (2020) Normal anatomy and variants of renal vasculature with multidetector computed tomography in a tertiary care hospital: a descriptive cross-sectional study. J Nepal Med Assoc 58:911–914

    Article  Google Scholar 

  23. Sarier M, Callioglu M, Yuksel Y, Duman E, Emek M, Usta SS (2020) Evaluation of the renal arteries of 2,144 living kidney donors using computed tomography angiography and comparison with intraoperative findings. Urol Int 104:637–640. https://doi.org/10.1159/000507796

    Article  PubMed  Google Scholar 

  24. Sośnik H, Sośnik K (2017) Investigations on renal vascularisation pathology in the Polish population. 1. Incidence of multiple kidney arteries. Folia Morphol (Warsz) 76:226–231. https://doi.org/10.5603/FM.a2016.0073

    Article  PubMed  Google Scholar 

  25. Standring S (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Churchill Livingstone Elsevier, Edinburgh

    Google Scholar 

  26. Tardo DT, Briggs C, Ahern G, Pitman A, Sinha S (2017) Anatomical variations of the renal arterial vasculature: an Australian perspective. J Med Imaging Radiat Oncol 61:643–649. https://doi.org/10.1111/1754-9485.12618

    Article  PubMed  Google Scholar 

  27. Tarzamni MK, Nezami N, Rashid RJ, Argani H, Hajealioghli P, Ghorashi S (2008) Anatomical differences in the right and left renal arterial patterns. Folia Morphol (Warsz) 67:104–110

    CAS  PubMed  Google Scholar 

  28. Tenorio ER, Kärkkäinen JM, Marcondes GB, Lima GBB, Mendes BC, DeMartino RR, Macedo TA, Oderich GS (2021) Impact of intentional accessory renal artery coverage on renal outcomes after fenestrated-branched endovascular aortic repair. J Vasc Surg 73:805–818. https://doi.org/10.1016/j.jvs.2020.06.123

    Article  PubMed  Google Scholar 

  29. Vas D, Moreno Rojas J, Solà Garcia M (2022) Replaced right hepatic artery arising from the distal renal artery, a new variation. Surg Radiol Anat 44:1339–1342. https://doi.org/10.1007/s00276-022-03017-3

    Article  PubMed  Google Scholar 

  30. VonAchen P, Hamann J, Houghland T, Lesser JR, Wang Y, Caye D, Rosenthal K, Garberich RF, Daniels M, Schwartz RS (2016) Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation. Cardiovasc Revasc Med 17:470–473. https://doi.org/10.1016/j.carrev.2016.07.009

    Article  PubMed  Google Scholar 

  31. Wang J, Li Y, **ao N, Duan J, Yang N, Bao J, Li Y, Mi J (2014) Retroperitoneoscopic resection of primary paraganglioma: single-center clinical experience and literature review. J Endourol 28:1345–1351. https://doi.org/10.1089/end.2014.0345

    Article  PubMed  Google Scholar 

  32. Yeh BM, Coakley FV, Meng MV, Breiman RS, Stoller ML (2004) Precaval right renal arteries: Prevalence and morphologic associations at spiral CT. Radiology 230:429–433. https://doi.org/10.1148/radiol.2302021030

    Article  PubMed  Google Scholar 

  33. Zorgdrager M, Krikke C, Hofker SH, Leuvenink HG, Pol RA (2016) Multiple renal arteries in kidney transplantation: a systematic review and meta-analysis. Ann Transplant 21:469–478

    Article  PubMed  Google Scholar 

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Radiology, Prof. Dr. Alexander Chirkov University Hospital, Pencho Slaveykov Blvd, 1431 52A, Sofia, Bulgaria

    Evgeniya Mihaylova, Violeta Groudeva & Maria Nedevska

  2. Department of Radiology, Medical University Sofia, Sofia, Bulgaria

    Evgeniya Mihaylova, Violeta Groudeva & Maria Nedevska

Authors
  1. Evgeniya Mihaylova
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  2. Violeta Groudeva
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  3. Maria Nedevska
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Contributions

EM: conceptualization, data collection and analysis, original manuscript preparation. VG: Data analysis, work supervision, manuscript review. MN: Material preparation, data analysis, manuscript editing.

Corresponding author

Correspondence to Evgeniya Mihaylova.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Research was conducted on already available patient data obtained for clinical purposes. Informed consent and ethical approval were waived by local ethics due to the retrospective nature of the study.

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Mihaylova, E., Groudeva, V. & Nedevska, M. Multidetector computed tomography angiography study of the renal arterial vasculature anatomy and its variations in a Bulgarian adult population. Surg Radiol Anat 45, 289–296 (2023). https://doi.org/10.1007/s00276-023-03092-0

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  • DOI: https://doi.org/10.1007/s00276-023-03092-0

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