ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2018, 3(7): 227–233
https://doi.org/10.26693/jmbs03.07.227
Medicine. Reviews

MSCT Angiography in Estimation of Anatomic Variants of Kidney Artery

Smirnov S. V.
Abstract

Anatomical variants of the renal vessels both arteries and veins occur quite often. Reliable knowledge of vascular anatomy is a significant aspect in the planning of surgical interventions. The purpose of this study was visualization of variants of kidneys vascular systems, and presentation of reconstructions of variants of arterial blood supply of the most frequently occurring kidneys. Traditional angiography is still considered the golden standard for the study of anatomy of the abdominal cavity vessels. However, the development of multidetector spiral computed tomography (MSCT), in combination with the methods of digital image reconstruction, provided the possibility of angiography without the need for invasive angiographic techniques that present a certain risk to the patient together with an opportunity to assess the anatomical and functional status of kidneys and adjacent organs. The results of visual research methods are the most important tool in planning surgical interventions such as nephritis, pyeloplastics, kidney transplantation, and others. Possession of complete anatomical information may influence the choice of the surgical treatment method. Taking into account the increase in the number of organ-saving operations in neonates and kidney transplants, the need for a more detailed visualization of the anatomy of the regional vascular bed of the kidney and its variants has increased. In the planning of renal resection, information about anatomy of the vessels is vital. Reducing the time of warm ischemia is one of the technical factors of the operation, which can improve the functional outcome. The difference in such cases will be the temporary imposition of the clamping on the segmental artery instead of the main, which improves the function of the kidneys in the early postoperative period. The possibility of creating a three-dimensional model of the vascular bed of the kidney with the help of MSCT allows a more precise application of a surgical technique. When a kidney transplant is from a living donor, the identification of a single renal artery is a positive factor and reduces the number of complications. The blood supply variants increase the number of thrombosis, prolong the time of warm ischemia, increase blood loss, complicate the implementation of anastomosis. They also increase the risk of fistulas and ureter formations development. However, the anatomical variants of blood supply do not affect the level of rejection of the graft after 1 year and 5 years of observation.

Keywords: renal artery, anatomical variants, multidetector spiral computed tomography

Full text: PDF (Rus) 448K

References
  1. Apisarnthanarak P, Suvannarerg V, Muangsomboon K, Taweemonkongsap T, Hargrove NS. Renal vascular variants in living related renal donors: evaluation with CT angiography. J Med Assoc Thai. 2012 Jul; 95(7): 941-8. https://www.ncbi.nlm.nih.gov/pubmed/22919990
  2. Dăescu E, Zăhoi DE, Motoc A, Alexa A, Baderca F, Enache A. Morphological variability of the renal artery branching pattern: a brief review and an anatomical study. Rom J Morphol Embryol. 2012; 53(2): 287-91. https://www.ncbi.nlm.nih.gov/pubmed/22732797
  3. Gill IS, Patil MB, Abreu AL, Ng C, Cai J, Berger A, et al. Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol. 2012; 187: 807-14. https://www.ncbi.nlm.nih.gov/pubmed/22248519. https://doi.org/10.1016/j.juro.2011.10.146
  4. Gümüş H, Bükte Y, Ozdemir E, Cetinçakmak MG, Tekbaş G, Ekici F, et al. Variations of renal artery in 820 patients using 64-detector CT-angiography. Ren Fail. 2012; 34(3): 286-90. https://www.ncbi.nlm.nih.gov/pubmed/22251313. https://doi.org/10.3109/0886022X.2011.647295
  5. Kawamoto S, Montgomery RA, Lawler LP, Horton KM, Fishman EK. Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors. AJR Am J Roentgenol. 2003 Jun; 180(6): 1633-8. https://www.ncbi.nlm.nih.gov/pubmed/12760934. https://doi.org/10.2214/ajr.180.6.1801633
  6. Kang WY, Sung DJ, Park BJ, Kim MJ, Han NY, Cho SB, et al. Perihilar branching patterns of renal artery and extrarenal length of arterial branches and tumour-feeding arteries on multidetector CT angiography. Br J Radiol. 2013 Mar; 86(1023): 20120387. https://www.ncbi.nlm.nih.gov/pubmed/23418206. https://www.ncbi.nlm.nih.gov/pmc/articles/3608057. https://doi.org/10.1259/bjr.20120387
  7. Meng X, Mi Q, Fang S, Zhong W. Preoperative evaluation of renal artery anatomy using computed tomography angiography to guide the superselective clamping of renal arterial branches during a laparoscopic partial nephrectomy. Exp Ther Med. 2015 Jul; 10(1): 139-44. https://www.ncbi.nlm.nih.gov/pubmed/26170925. https://www.ncbi.nlm.nih.gov/pmc/articles/4487048. https://doi.org/10.3892/etm.2015.2500
  8. Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P. Horseshoe kidney: a review of anatomy and pathology. Surg Radiol Anat. 2014 Aug; 36(6): 517-26. https://www.ncbi.nlm.nih.gov/pubmed/24178305. https://doi.org/10.1007/s00276-013-1229-7
  9. Palmieri BJ, Petroianu A, Silva LC, Andrade LM, Alberti LR. Study of arterial pattern of 200 renal pedicle through angiotomography. Rev Col Bras Cir. 2011; 38: 116–21. https://www.ncbi.nlm.nih.gov/pubmed/21710050
  10. Rocco F, Cozzi LA, Cozzi G. Study of the renal segmental arterial anatomy with contrast-enhanced multi-detector computed tomography. Surg Radiol Anat. 2015 Jul; 37(5): 517-26. https://www.ncbi.nlm.nih.gov/pubmed/25307353. https://doi.org/10.1007/s00276-014-1382-7
  11. Reginelli A, Somma F, Izzo A, Urraro F, D'Andrea A, Grassi R, Cappabianca S. Renovascular anatomic variants at CT angiography. Int Angiol. 2015 Dec; 34(6 Suppl 1): 36-42. https://www.ncbi.nlm.nih.gov/pubmed/26498890
  12. Sampaio FJB, Passos MARF. Renal arteries: anatomic study for surgical and radiological practice. Surg Radiol Anat. 1992; 14: 113–7. https://www.ncbi.nlm.nih.gov/pubmed/1641734
  13. Shetty A, Adiyat KT. Comparison between helical computed tomography angiography and intraoperative findings. Urol Ann. 2014 Jul; 6(3): 192-7. https://www.ncbi.nlm.nih.gov/pubmed/25136246. https://www.ncbi.nlm.nih.gov/pmc/articles/4127853. https://doi.org/10.4103/0974-7796.134256
  14. Verma P, Arora AK, Sharma P, Mahajan A. Variations in branching pattern of renal artery and arrangement of hilar structures in the left kidney: clinical correlations, a case report. Ital J Anat Embryol. 2012; 117(2): 118-22. https://www.ncbi.nlm.nih.gov/pubmed/23420999
  15. Xu Y, Shao P, Zhu X, Lv Q, Liu W, Xu H, et al. Three-dimensional renal CT angiography for guiding segmental renal artery clamping during laparoscopic partial nephrectomy. Clin Radiol. 2013 Nov; 68(11): e609-16. https://www.ncbi.nlm.nih.gov/pubmed/23916549. https://doi.org/10.1016/j.crad.2013.06.002