{"id":26273,"date":"2019-03-25T10:18:44","date_gmt":"2019-03-25T10:18:44","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=26273"},"modified":"2020-04-23T10:42:35","modified_gmt":"2020-04-23T10:42:35","slug":"analysis-of-intra-renal-arterial-pattern-in-kidney-donors-using-64-slice-computed-tomography-angiography","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol12no1\/analysis-of-intra-renal-arterial-pattern-in-kidney-donors-using-64-slice-computed-tomography-angiography\/","title":{"rendered":"Analysis of Intra Renal Arterial Pattern in Kidney Donors using 64-Slice Computed Tomography Angiography"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

The renal artery is one of the lateral branches of abdominal aorta, as it reaches closer to the kidney it splits into anterior and posterior division were it receives around 75% and 25% of blood respectively. Further these branches divide into many segmental branches. These segmental arteries does not have collateral system, so when there is any occlusion of these arteries which results in the ischemia of the particular segment of kidney.1<\/sup>If lower polar accessory renal artery is present in the infant, it should be noted to be in close relation to main renal artery and not to ureter.<\/p>\n

In later part of life the poles of kidney are separated from the main artery in such a case it could obstruct the ureter.2<\/sup>\u00a0Interestingly, a recent study result tells the reality about the galactosemia patients should be monitored for anomalies of renal vessels.3<\/sup>\u00a0Anatomists believe that precise knowledge of presence of lower polar artery is essential for polar nephrectomy. Prior awareness of anomalous of renal artery is needed for the urologist in preoperative findings as there are reports surgical complications which enormous haemorrhage.4<\/sup>\u00a0There are very less reports of additional renal artery to poles of kidney. Arrival of renal artery into the kidney other than usual route is considered as infrequent findings.5<\/sup>\u00a0The entire accessibility rate for inferior segmental artery rate was 88.5% from an anterior and 66.7% from a posterior surgical approach.6,7,8<\/sup>\u00a0This present study is to analyze the intra renal arterial pattern of inferior segmental artery in kidney donors. This study results not only gives information to intra-renal surgeries but also for renal transplantation.<\/p>\n

Materials and Methods<\/strong><\/p>\n

In this study 99 CT angiogram images were analyzed in work station of specialized scan centre in Chennai after getting approval from the Institutional Human Ethics Committee, Saveetha Medical College – IHEC No. 001\/09\/2015\/IEC\/SU.The CT machine used was light speed VCTXTe, ADW 4.5 Version, 64 slice Computed Tomography Angiography. The study group was drawn from kidney donors who approached the scan center had no diseases related to kidney. Out of 99 donors there were 54male, and 45 were female. Inferior segmental branch of renal artery is classified into four types depending upon the mode of its origin [kher et al]. They are\u00a0<\/strong><\/p>\n

Type I<\/strong><\/p>\n

Inferior segmental branch arises from the anterior division of renal artery.<\/p>\n

Type II<\/strong><\/p>\n

Inferior segmental branch arises from the posterior division of renal artery.<\/p>\n

Type III<\/strong><\/p>\n

Inferior segmental branch emerges from the main renal artery.<\/p>\n

Type IV<\/strong><\/p>\n

Inferior segmental branch arises either above or below the main renal artery from aorta.<\/p>\n

Observation and Results<\/strong><\/p>\n

Percentage of occurrence of pattern of origin of inferior segmental artery is given below. Among the 99 donors (198 kidneys), type 1 is seen in 66 kidneys on both sides, type 2 is seen in 6 kidneys on right side and 3 on left side, type 3 is seen around in 11 kidneys on right and 12 on left, type 4 is seen in 12 kidneys on right side and 13 on left side. Other patterns are seen in 4 kidneys on right and 5 on left side. In few kidneys we found an inferior segmental artery emerges from common iliac and middle segmental branch of renal artery.<\/p>\n\n\n\n
\"Graph<\/td>\nGraph 1: Showing the distribution of inferior segmental artery.<\/strong><\/p>\n

 <\/p>\n

Click here to view\u00a0graph<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

There is no association between the pattern of inferior segmental branch between right and left side, \u03c72 = 1.195; P = 0.879.<\/p>\n

Discussion<\/strong><\/p>\n

This present work reported that the inferior segmental artery type 1 arises from anterior division of renal artery found to be more frequent which is similar to previous studies by servo et al9<\/sup>\u00a0reported in 47% of cases, Raghavendra et al10<\/sup>\u00a0reported in 51.66%, Chandra Girish et al11<\/sup>\u00a0reported in 59% of cases and Fine H et al12<\/sup>\u00a0study not observed the type 1 inferior segmental artery. Results obtained in our study shows different percentage in compare to other results (Table 2).<\/p>\n

Table 1<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
Pattern<\/strong><\/td>\nRight <\/strong><\/td>\nLeft <\/strong><\/td>\n<\/tr>\n
Male (n=54)<\/strong><\/td>\nFemale(n=45)<\/strong><\/td>\nMale(n=54)<\/strong><\/td>\nFemale(n=45)<\/strong><\/td>\n<\/tr>\n
Type 1<\/td>\n37 (68.5%)<\/td>\n29 (64.4%)<\/td>\n37 (68.5%)<\/td>\n29 (64.4%)<\/td>\n<\/tr>\n
Type 2<\/td>\n4 (7.4%)<\/td>\n2 (4.4%)<\/td>\n3 (5.5%)<\/td>\nNil<\/td>\n<\/tr>\n
Type 3<\/td>\n5 (9.2%)<\/td>\n6 (13.3%)<\/td>\n6 (11.1%)<\/td>\n6 (13.3%)<\/td>\n<\/tr>\n
Type 4<\/td>\n6 (11.1%)<\/td>\n6 (13.3%)<\/td>\n5 (9.2%)<\/td>\n8 (17.7%)<\/td>\n<\/tr>\n
Others<\/td>\n2 (3.7%)<\/td>\n2 (4.4%)<\/td>\n3 (5.5%)<\/td>\n2 (4.4%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Values given in parenthesis are percentage. Statistical values are given in the below chart.<\/p>\n

Table 2: Comparison of inferior segmental branch with previous workers.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
Type<\/strong><\/td>\nVerma et al 1961<\/strong><\/td>\nRaghavendra et al 2007<\/strong><\/td>\nChandra Girish et al 2014<\/strong><\/td>\nPresent study 2018<\/strong><\/td>\n<\/tr>\n
Kidneys studied<\/td>\n98<\/td>\n60<\/td>\n100<\/td>\n198<\/td>\n<\/tr>\n
Type I<\/td>\n88%<\/td>\n51.66%<\/td>\n59%<\/td>\n66.6%<\/td>\n<\/tr>\n
Type II<\/td>\n1.02%<\/td>\n8.33%<\/td>\n6%<\/td>\n4.5%<\/td>\n<\/tr>\n
Type III<\/td>\n3.06%<\/td>\n10%<\/td>\n28%<\/td>\n11.6%<\/td>\n<\/tr>\n
Type IV<\/td>\n–<\/td>\n28.33%<\/td>\n2%<\/td>\n12.6%<\/td>\n<\/tr>\n
Other pattern<\/td>\n–<\/td>\n–<\/td>\n–<\/td>\n4.5%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

And this is the only angiographic study to find out the variations in inferior branch of renal artery in live donors, so compare to the previous study the results shows great significance. We also compared not only the variations in the sides but we found the gender differences. In this current study, type I and type II are more frequent in male on both sides whereas Type III and IV are more frequent in female on both sides. There is no association within the pattern of inferior segmental branch of renal artery between right and left side c2 = 1.195; P = 0.879. The presence of accessory lower polar artery prevail as the kidneys ascend upwards they are nourished by a succession of momentary aortic sprouts that emerge at gradually higher levels. Such arteries will not elongate to follow the ascending kidney but instead dissipated and are replaced by recent arteries. The final pair of arteries forms in the lumbar region and becomes the definitive renal arteries. <\/strong>Rarely, a inferior pair of arteries persistent as additional inferior polar arteries. Additional renal arteries can emerge from the abdominal aorta aloft the main branch or as low (inferiorly) as the internal iliac artery.13<\/sup>\u00a0Diverse origins may be from ventral branches of abdominal aorta such as, celiac, superior and inferior mesenteric and also from middle colic, lumbar, middle sacral and opposite side renal arteries have been reported.14<\/sup><\/p>\n\n\n\n
\u00a0\"Figure<\/td>\nFigure 1: Showing the classification of Inferior Segmental artery depending upon its origin.<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 2: Showing the origin of inferior segmental artery from common iliac artery.<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

The presence of such anomalies may be important from the academic, anthropological and radiological point of view.15<\/sup><\/p>\n

Conclusion<\/strong><\/p>\n

The precise knowledge of intra renal arterial branches will provide a informative benefaction for surgeons in performing more conservative renal surgeries like partial and segmental resection of renal tissue instead of going for comprehensive nephrectomy.<\/p>\n

Acknowledgements<\/strong><\/p>\n

I thank the Department of Anatomy, Saveetha Medical College and Hospital.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

There is no conflict of interest.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Mc Dougal.,\u00a0 Wein A., Kavoussi L., Novick A., Partin A., Peters C., Campbell-Walsh U. 10th<\/sup> ed, saunder elseiver. 2012;602-605.<\/li>\n
  2. Stewart H. H.\u00a0 A new operation for the treatment of hydronephrosis in association with a lower pole (or aberrant artery). B.J.S<\/em>. 1947;35:51-57.<\/li>\n
  3. Mizoguchi N., Sakura N., Ono H., Naito K., Hamakawa M. Congenital porto-left renal venous shunt as a cause of galactosemia. J Inherit Metab Dis<\/em>. 2001;24(1):72-78.
    \n    CrossRef<\/a><\/li>\n
  4. Toda R., Iguro Y., Moriyama Y., Hisashi Y., Masuda H., Sakata R. Double left renal vein associated with abdominal aortic aneurysm. Ann Thoracic cardio vasc surg<\/em>. 2001;24(1):72-78.<\/li>\n
  5. Gesase A. P. Rare origin of supernumerary renal vessels supplying the lower pole of the kidney. Ann Anat.<\/em> 2007;189(1):53-58.
    \n    CrossRef<\/a><\/li>\n
  6. Weld K. J.,\u00a0Bhayani S. B.,\u00a0Belani J., Ames C.\u00a0 D.,\u00a0Hruby G.,\u00a0Landman J. Extrarenal vascular anatomy of kidney: Assessment of variations and their relevance to partial nephrectomy Urology. 2005;66(5):985-989.
    \n    CrossRef<\/a><\/li>\n
  7. Kher G. A., Bhargava I., Makhni F. S. Intrarenal branching of the renal artery.\u00a0Ind J of Surg.<\/em> 1960;22:563-79.<\/li>\n
  8. Verma M., Chaturvedin R. P., Pathak R. K. Anatomy of the renal vascular segments. J Anat Soc.\u00a0<\/em>1961;10:12-14.<\/li>\n
  9. Servo V. V. Segmental arterial distribution in the human kidney. J of Urol.<\/em> 1959;24-26.<\/li>\n
  10. Raghavendra V. P., Manjappa T. Anjana Telkar Renal Apical Segmental Artery Variations and Their Surgical Importance. Journal of Clinical and Diagnostic Research<\/em>. 2012;6(4):561-563.(Suppl2).<\/li>\n
  11. Chandragirish S., Nanjaiah C. M., \u00a0Shirur Y .S., Saheb H. S. Study on Variations of Posterior Division of Renal Artery. Int J Anat Res<\/em>. 2014;2(4):709-11. ISSN 2321-4287.<\/li>\n
  12. Fine H and Keen E. N. The arteries of the human kidney. J. Anat<\/em>. 1966;100(4):881-894.<\/li>\n
  13. Boijsen E Anomalies and malformations. In: Abrams HL Abrams angiography, 2nd<\/sup> edn. Little, Brown, Boston. 1983;1217-1221.<\/li>\n
  14. Cuttino J. T., Clark R. L The normal vasculature of the genitourinary tract: embryology anatomy and hemodynamics. In: Hillman B. J. Clinical urography,\u00a0 Saunders, Philadelphia.\u00a03:2076-2091.<\/li>\n
  15. \u00a0Pa Pa Hlaing K., Das S., Sulaiman M. I.,Latiff A. A., Ghafar A. N.,Suhaimi H. F. Accessory renal vessels at the upper and lower pole of the kidney a cadaveric study with clinical implications. Bratisl Lek Listy.\u00a0<\/em>2010;111(5):308-10.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction The renal artery is one of the lateral branches […]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[63],"tags":[],"class_list":["post-26273","post","type-post","status-publish","format-standard","hentry","category-vol12no1"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/26273","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=26273"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/26273\/revisions"}],"predecessor-version":[{"id":32407,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/26273\/revisions\/32407"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=26273"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=26273"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=26273"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}