Background. Classically, each kidney is supplied by a single renal artery originating from abdominal aorta. The present study aimed at its variations and their embryological and clinical correlation. Material and Methods. The formalin-fixed thirty-seven cadavers from north India constituted the material for the study. During routine abdominal dissection conducted for medical undergraduates at the department of anatomy, the kidneys along with their arteries were explored and the morphological variations of renal arteries were noted. Results. We observed supernumerary renal arteries in 23/37 (62.2%) cases (48.6% of aortic origin and 13.5% of renal origin) on the right side and 21/37 (56.8%) cases (45.9% of aortic origin and 10.8% of renal origin) on the left side. Supernumerary renal arteries entered the kidney through hilum, superior pole, and inferior pole. Conclusion. Awareness of variations of renal artery is necessary for surgical management during renal transplantation, repair of abdominal aorta aneurysm, and urological procedures and for angiographic interventions. 1. Introduction Classically, the description of a single renal artery arising from abdominal aorta that supplies the respective kidney [1, 2] occurs in less than 25% of cases [3, 4]. Common variations of renal artery are its variable number and unusual branching pattern [5–9]. Variations in renal arteries have been called aberrant, supplementary, and accessory, among other terms. We used the term supernumerary and analyze it in accordance with Merklin classification [10]. We believe that prior knowledge of these possible variations of renal arteries may help the surgeon in planning renal transplantation, repair of abdominal aorta aneurysm, urological procedures, and also for angiographic interventions [11–13]. 2. Materials and Methods The formalin-fixed thirty-seven cadavers constituted the material for the study. During routine abdominal dissection conducted for medical undergraduates at the department of anatomy, the kidneys along with their arteries were explored and the morphological variations of renal arteries were noted. During the course of dissection various abdominal viscera were removed and preserved as specimens for teaching purposes. We studied the origin of supernumerary renal arteries in accordance to the nomenclature of Merklin and Michels [10]: (1)supernumerary renal arteries originating from the aorta;(2)supernumerary renal arteries originating from main renal arteries;(3)supernumerary renal arteries that can come from other sources. 3. Results Supernumerary renal
References
[1]
J. P. Beregi, B. Mauroy, S. Willoteaux, C. Mounier-Vehier, M. Rémy-Jardin, and J. P. Francke, “Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation,” European Journal of Radiology, vol. 9, no. 7, pp. 1330–1334, 1999.
[2]
U. ？zkan, L. O？uzkurt, F. Tercan, O. Kizilkili？, Z. Ko？, and N. Koca, “Renal artery origins and variations: angiographic evaluation of 855 consecutive patients,” Diagnostic and Interventional Radiology, vol. 12, no. 4, pp. 183–186, 2006.
[3]
O. A. Awojobi, O. A. Ogunbiyi, and E. O. Nkposong, “Unusual relationship of multiple renal arteries,” Urology, vol. 21, no. 2, pp. 205–206, 1983.
[4]
A. E. ？i？ekciba？i, T. Ziylan, A. Salbacak, M. ？eker, M. Büyükmumcu, and I. Tuncer, “An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance,” Annals of Anatomy, vol. 187, no. 4, pp. 421–427, 2005.
[5]
P. Dhar and K. Lal, “Main and accessory renal arteries—a morphological study,” Italian Journal of Anatomy and Embryology, vol. 110, no. 2, pp. 101–110, 2005.
[6]
M. C. Rusu, “Human bilateral doubled renal and testicular arteries with a left testicular arterial arch around the left renal vein,” Romanian Journal of Morphology and Embryology, vol. 47, no. 2, pp. 197–200, 2006.
[7]
M. M. Shoja, R. S. Tubbs, A. Shakeri et al., “Peri-hilar branching patterns and morphologies of the renal artery: a review and anatomical study,” Surgical and Radiologic Anatomy, vol. 30, no. 5, pp. 375–382, 2008.
[8]
N. Krishnasamy, M. Rao, S. N. Somayaji, S. Koshy, and V. Rodrigues, “An unusual case of unilateral additional right renal artery and vein,” International Journal of Anatomical Variations, vol. 3, pp. 9–11, 2010.
[9]
F. J. B. Sampaio and M. A. R. F. Passos, “Renal arteries: anatomic study for surgical and radiological practice,” Surgical and Radiologic Anatomy, vol. 14, no. 2, pp. 113–117, 1992.
[10]
R. J. Merklin and N. A. Michels, “The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries: a statistical analysis based on 185 dissections and review of the literature,” The Journal of the International College of Surgeons, vol. 29, no. 1, pp. 41–76, 1958.
[11]
O. Olsson and M. Wholey, “Vascular abnormalities in gross anomalies of kidneys,” Acta Radiologica, vol. 2, pp. 420–432, 1964.
[12]
H. Nathan and I. Glezer, “Right and left accessory renal arteries arising from a common trunk associated with unrotated kidneys,” Journal of Urology, vol. 132, no. 1, pp. 7–9, 1984.
[13]
K. S. Satyapal, A. A. Haffejee, B. Singh, L. Ramsaroop, J. V. Robbs, and J. M. Kalideen, “Additional renal arteries: incidence and morphometry,” Surgical and Radiologic Anatomy, vol. 23, no. 1, pp. 33–38, 2001.
[14]
B. J. Anson, G. A. Richardson, and W. L. Minear, “Variations in the number and arrangements of the renal blood vessels, a study of the blood supply of four hundred kidneys,” Journal of Urology, vol. 36, pp. 211–219, 1936.
[15]
D. Sykes, “The arterial supply of the human kidney with special reference to accessory renal arteries,” The British Journal of Surgery, vol. 50, pp. 368–374, 1963.
[16]
G. Singh, Y. K. Ng, and B. H. Bay, “Bilateral accessory renal arteries associated with some anomalies of the ovarian arteries: a case study,” Clinical Anatomy, vol. 11, no. 6, pp. 417–420, 1998.
[17]
E. Talovic, A. Kulenovic, A. Voljevica, and E. Kapur, “Review of supernumerary renal arteries by dissection method,” Acta Medica Academica, vol. 36, pp. 59–69, 2007.
[18]
W. Felix, “Mesonephric arteries (aa. mesonephrica),” in Manual of Human Embryology, F. Keibel and F. P. Mall, Eds., vol. 22, pp. 820–825, Lippincott, Philadelphia, Pa, USA, 1912.
[19]
R. W. Beyer and P. O. Daily, “Renal Artery Dissection Associated with Gz Acceleration,” Aviation Space and Environmental Medicine, vol. 75, no. 3, pp. 284–287, 2004.
[20]
M. M. Shoja, R. S. Tubbs, A. Shakeri, M. R. Ardalan, B. Rahimi-Ardabili, and K. Ghabili, “Asymptomatic bilateral ureteropelvic junction obstruction due to supernumerary renal arteries,” Saudi Journal of Kidney Disease and Transplantation, vol. 19, no. 5, pp. 806–808, 2008.
[21]
G. E. Brannen, W. H. Bush, and R. J. Correa, “Microvascular management of multiple renal arteries in transplantation,” Journal of Urology, vol. 128, no. 1, pp. 112–115, 1982.
