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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.
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