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Clinical Anatomy 19:714–715 (2006) COMPENDIUM OF ANATOMICAL VARIANTS Bilateral Accessory Renal Arteries With Retroaortic Left Renal Vein: Report of an Elderly Cadaver Case B. BAMAC* AND T. COLAK Department of Anatomy, School of Medicine, Kocaeli University, Turkey Accessory renal arteries are frequently present and they usually enter the superior or inferior poles of the kidney (Khamanarong et al., 2004; Çicekcibasi et al., 2005). Retroaortic left renal vein (RLRV) is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava (IVC) crossing posterior to the aortic artery (Arslan et al., 2005). RLRV occurs infrequently (Karkos et al., 2001; Kudo et al., 2003). Its incidence ranges from 0.8 to 3.7% (Karkos et al., 2001). We report the case of a cadaver in which a combination of these anomalies of the accessory renal arteries and RLRV were present. Bilateral accessory renal arteries and RLRV were observed during routine dissection in a 67-year-old Turkish female cadaver. The main renal arteries arose from the lateral surface of the aorta with a symmetric origin, nearly 10 cm below the origin of the superior mesenteric artery. On the left side, an accessory renal artery arose from the aorta at about level with the origin of the inferior mesenteric artery, crossed posterior to the ovarian vein and ureteropelvic junction and entered into the lower part of the left kidney. On the right side, it arose from the aorta at 5 cm inferior to the level of the origin of the inferior mesenteric artery, passed anterior to the IVC and posterior to the ovarian vein and entered into the lower part of the right kidney. Both of them pierced the renal substance directly (Fig. 1). As seen in Figure 1, the left renal vein received the ovarian, inferior phrenic and suprarenal veins and passed behind the aorta then drained into IVC. We have found only one report of a bilateral accessory renal artery with RLRV. Kudo et al. (2003) presented a case report of abdominal aortic aneurysm Fig. 1. Photographic representation of the bilateral accessory renal arteries and retroaortic left renal vein. (IVC, inferior vena cava; Ao, aorta; Ur, ureter; IM, inferior mesenteric artery; SM, superior mesenteric artery; RA, renal artery; ROV, right ovarian vein; LOV, left ovarian vein; RARA, right accessory renal artery; LARA, left accessory renal artery; RLRV, retroaortic left renal vein). [Color ﬁgure can be viewed in the online issue, which is available at www. interscience.wiley.com.] *Correspondence to: Dr. Belgin Bamac, Department of Anatomy, School of Medicine, Kocaeli University, Umuttepe, Kocaeli, Turkey. E-mail: [email protected] C 2006 V Wiley-Liss, Inc. Received 22 February 2006; Revised 20 July 2006; Accepted 8 August 2006 Published online 4 October 2006 in Wiley InterScience (www. interscience.wiley.com). DOI 10.1002/ca.20422 Accessory Renal Arteries with RLRV. They observed also the left polar renal artery arising near the inferior mesenteric artery. In recent years, extensive research has been reported showing certain surgical and medical aspects of accessory renal arteries. Transplanting a kidney with accessory renal arteries has several theoretical disadvantages (increased incidence of acute tubular necrosis and rejection episodes, decreased graft function, and prolonged hospitalization) (Cicekcibasi et al., 2005). In addition, ureter complications may occur if accessory arteries are present at the inferior pole of the kidney (Okamoto et al., 2006). Clinical signiﬁcance of RLRV has been described previously. Haematuria, pain, thrombosis, left renal vein hypertension, and varicocele are some of the reported clinical entities related to RLRV (Arslan et al., 2005). Furthermore, RLRV poses potential hazards to the surgeon during abdominal aortic surgery. In repair of an abdominal aortic aneurysm where the aorta is mobilized, the RLRV becomes an even larger obstacle. The risk of accidentally damaging a RLRV is higher for the surgeons who routinely dissect the aorta circumferentially to apply the proximal crossclamp. Careful preoperative evaluations are important for establishing the presence of an associated venous anomaly to ensure the success of abdominal aortic surgery (Satyapal et al., 1999; Karkos et al., 2001; Kudo et al., 2003). In conclusion, detailed knowledge of the presence of potential variations in 715 renal arterial and venous anatomy is important for retroperitoneal surgery. ACKNOWLEDGMENT The authors thank Aydın Özbek for constructive criticism of the manuscript. REFERENCES Arslan H, Etlik O, Ceylan K, Temizoz O, Harman M, Kavan M. 2005. Incidence of retro-aortic left renal vein and its relationship with varicocele. Eur Radiol 15:1717–1720. Çicekcibasi AE, Ziylan T, Salbacak A, Seker M, Buyukmumcu M, Tuncer I. 2005. An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance. Ann Anat 187:421–427. Karkos CD, Bruce IA, Thomson GJ, Lambert ME. 2001. Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg 15:703–708. Khamanarong K, Prachaney P, Utraravichien A, Tong-Un T, Sripaoraya K. 2004. Anatomy of renal arterial supply. Clin Anat 17:334–336. Kudo FA, Nishibe T, Miyazaki K, Flores J, Yasuda K. 2003. Left renal vein anomaly associated with abdominal aortic aneurysm surgery: report of a case. Surg Today 33:609–611. Okamoto K, Kodama K, Kawai K, Wakebe T, Saiki K, Nagashima S. 2006. The inferior supernumerary renal arteries: A classiﬁcation into three types. Ann Anat 188:49–53. Satyapal KS, Kalideen JM, Haffejee AA, Singh B, Robbs JV. 1999. Left renal vein variations. Surg Radiol Anat 21:77–81.