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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 11-14

Morphometric study of renal artery and its variations in level of origin


1 Assistant Professor, Department of Anatomy, Saveetha Medical College and Hospital, Chennai, India
2 Tutor, Department of Anatomy, Saveetha Medical College and Hospital, Chennai, India

Date of Web Publication29-Nov-2019

Correspondence Address:
P K Sankaran
18, Pillaiyar Koil St., Thirumazhisai, Chennai-600 124
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background : Knowledge of morphometry and variations of renal artery is of utmost surgical importance. Forcible retraction of vascular pedicle can cause rupture of blood vessel and can lead to fatal hemorrhage. So, the exact measurement of renal artery and its variation in level of origin is important for renal transplantation surgeries, stent surgeries and in cases of renal vascular hypertension. Aim: To determine the length and diameter of main renal artery and to find out the variation in the level of origin. Materials and methods: In this study, CT images of kidneys of 100 males of above 20 years of age were collected from scan center in Chennai. The length of renal artery was measured from the level of origin to the hilum and diameter was measured near the ostium and hilum of kidney. Also the variation in the level of origin of renal artery was observed. Measurements were compared between right and left side. Results: Mean length of main right renal artery was 3.73 ± 1,28cms and diameter near ostium and hilum was 0.63 ± 0.12cm and 0.55 ± 0.12cm respectively. Mean length of main left renal artery was 2.84 ± 1.18cm and diameter near ostium and hilum was 0.65 ± 0.98cm and 0.54 ± 0.11cm respectively. Majority of renal arteries arise at the level of LI on both side. ConclusionrThe most common level of origin of renal artery is at the level of LI vertebra on both sides. The average length of right renal artery is greater than left renal artery and the diameter of left renal artery is greater than right renal artery.

Keywords: hilum, ostium, CT angiography, renal transplantation, vascular hypertension


How to cite this article:
Sankaran P K, Karthikeyan G, Kumaresan M. Morphometric study of renal artery and its variations in level of origin. Natl J Clin Anat 2016;5:11-4

How to cite this URL:
Sankaran P K, Karthikeyan G, Kumaresan M. Morphometric study of renal artery and its variations in level of origin. Natl J Clin Anat [serial online] 2016 [cited 2022 May 17];5:11-4. Available from: http://www.njca.info/text.asp?2016/5/1/11/297712




  Introduction Top


The paired renal arteries supply 20% of cardiac output to kidneys for filtration. They usually arise as lateral branch of aorta just below superior mesenteric artery (L1-L2). The right renal artery is little longer and at higher level than left renal artery. A single renal artery to each kidney is present in approximately 70% individuals. Classically, a single renal artery supplies each kidney. However, renal artery variations are very common. Variations regarding their origin and number have been reported by many researchers[1],[2],[3].

The arteries may vary in their level of origin and in caliber, obliquity and precise relation. The commonest site of origin of renal arteries is lateral (92%), and less commonly on anterolateral (6%) and posterolateral (2%) aspect of abdominal aorta[4] at the level of Ll-L2.The diameter of the renal arteries varies at two levels one at ostium and another at the hilum[5]. The frequencies of renal artery variations show ethnic and racial differences[6]. For example variations in renal artery and its branching pattern are more common in Africans and less common in Indians[7]. Renal arterial anatomy plays a vital role in selecting kidney donors since its impact on renal transplant surgeries[8]. The renal arteries were studied using CT angiography because it is one of the best modality for vascular anatomic evaluation[9]. Variations in the origin and course of the renal arterial blood supply occur frequently and are of special interest to the urologists, nephrologists, surgeons and radiologists, with respect to the diseases associated with it.

Aims and objectives of the present study are :

  1. To measure the length and diameter of renal artery
  2. To determine the various levels of origin of renal artery



  Materials and methods Top


For this study, CT angiographic images of 100 males of above 20 years of age were collected from Precision scan center, Chetpet in Chennai. Renal angiogram images were collected and analyzed for the length of renal artery and its level of origin. The length of renal artery was measured from ostium upto the divisions of segmental branches. The diameter was measured near the ostium of renal artery and hilum. Vertebral level of origin of renal artery in both sides of each individual were also observed and noted. The record obtained was entered in MS excel sheet for data analysis and data was analyzed with SPSS software for calculating mean and standard deviation.


  Results: Top


Morphometry of renal artery:

The mean length and diameter of renal artery [Figure 1] are tabulated in [Table 1] and [Table 2]. The average length of right renal artery is greater than left renal artery and diameter of left renal artery is greater than right renal artery.
Figure 1: Measurement of length of renal artery

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Table 1: Length of renal artery

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Table 2: Diameter of renal arteries.

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Level of origin of renal artery:

The level of origin [Figure 2] of renal artery in right side and left side are tabulated in [Table 3]. Renal artery originates at the level of L1 Vertebral level on both sides. The second commonest level at which renal artery arises is at L2 vertebral level. In only 1% of individuals right renal artery arises at level of L2-L3.
Figure 2: Level of origin of renal artery

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Table 3: Level of origin of renal arteries

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  Discussion Top


The origin of renal arteries and their variations can be explained by the development of mesonephric arteries. These mesonephric arteries supply the kidneys, suprarenal glands, and gonads on both sides of the aorta at the level between cervical six and lumbar three vertebrae, a region known as rete arteriosumurogenitale. As the development progress these arteries degenerate, leaving one prominent mesonephric artery.This artery undertakes arterial circulation of the kidneys. Deficiency in the development of mesonephric arteries results in more than one renal artery[10].

In the present study, nearly 50% of right renal arteries were found arising at the level of LI and more than 30% arose at the level of L2. Whereas on the left side nearly 60% of renal arteries were found arising at the level of LI and nearly 25% arose at the level of L2. This study differs from that of Kadir[6] which quoted nearly 75% arising at the level of L1 and L2 among the Philadelphian population.

In the present study, the average length of renal artery of right side was 3.73 ± 1.28 cms and of left side 2.84 ± 1.18 cms which are comparable to the study of Bladimir[11] in Columbian population. These length measurements can be useful to surgeons during kidney transplantation surgeries. In right side the length varied between 0.6 cm to 5.9 cm and in left side the length varied between 0.5 to 5.3 cm. The information regarding the variation of length can prevent undue accidents while surgeons operating in that area. The measurements of mean diameter of renal arteries can be useful to diagnose stenosis of renal arteries and during placement of renal artery grafts and stenting to correct it.

From this study, it is revealed that the left renal artery near ostium is 0.02 cm wider than right and for this reason, left kidney can be more preferable for transplantation than right kidney. The diameter of the renal artery correlates with study done by Turba et al[8] in donor population where the right renal artery ostial diameter was less than the left renal artery ostial diameter. The importance of this study is seen in the fact that anatomic knowledge of variations in the vascularization of kidney is of exceptional practical importance. Also this information may concern transplant surgeons involved in living donor nephrectomies[12]. The surgical accessibility to clamping of segmental arteries from anterior and posterior approaches was determined by Weld KJ et al[13].

However this study did not come across any accessory renal artery which is supposed to be the commonest variation of renal artery. Also this study did not see earlier divisions of renal arteries into segmental arteries. Measurement of renal artery is very important for stenting and also for transplantation. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urological procedures, vascular operations for renal artery stenosis, uro-radiological procedures and also for medical device development. This data can be useful in development of new devices or techniques which may significantly increase the number of candidates for those promising therapeutic options[14],[15] in interpreting, managing, surgical approaches and diagnosing functional alterations.


  Conclusion Top


The most common level of origin of renal artery is at the level of LI vertebra on both sides. The average length of right renal artery is greater than left renal artery and the diameter of left renal artery is greater than right renal artery. Normal renal arterial information is not only useful for planning and performing of endovascular and laparoscopic, urological procedure but also for using renal fragment for transplantation and for medical device development.



 
  References Top

1.
Shakeri AB, Tubbs RS, Shoja MM, Pezeshk P, farahani rm, Khaki AA, Ezzati F, Seyednejad F. Bipolar supernumerary renal artery. Surg Radiol Anat. 2007; 29(l):89-92.  Back to cited text no. 1
    
2.
Rao M, Bhat SM, Venkataramana V, Deepthinath R, Bolla SR. Bilateral prehilar multiple branching of renalarteries: a case report and literature review. Kathmandu University Medical Journal (KUMJ). 2006; 4(3):345-348.  Back to cited text no. 2
    
3.
Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries incidence and morphometry. Surg Radiol Anat. 2000; 23(1): 33-38.  Back to cited text no. 3
    
4.
Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Renal artery. In: Bergman RA, Thompson SA, Afifi AK, Saadeh FA, (eds.) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. 2nd ed. Urban & Schwarzenberg. Baltimore and Munich, 1988: 81-82.  Back to cited text no. 4
    
5.
Standring S. Gray’s Anatomy. The anatomical basis of clinical practice. Churchill Livingstone. London, 2008;40:1183.  Back to cited text no. 5
    
6.
Kadir S. Kidneys. In: Kadir S, (ed.) Atlas of normal and variant angiographic anatomy. W.B. Saunders Company. Philadelphia, 1991; 387-429.  Back to cited text no. 6
    
7.
Boijsen E. Renal angiography: Techniquesand hazards; anatomic and physiologic considerations. In: Baum S. (ed.) Abrams’angiography. 4th ed. Little,Brown and Company. Philadelphia, 1997; 1101-1131.  Back to cited text no. 7
    
8.
Turba UC1, Uflacker R, Bozlar U, Hagspiel KD. Normal renal arterial anatomy assessed by multi detector CT angiography: are there differences between men and women? Clin Anat. 2009 ; 22(2):236-42.  Back to cited text no. 8
    
9.
Thatipelli MR, Sabater EA, Bjarnason H, McKusick MA, Misra S. CT angiography of renal artery anatomy for evaluating embolic protection devices. J Vase Interv Radiol. 2007 ;18(7):842-6.  Back to cited text no. 9
    
10.
Boijsen E. Anomalies and malformations. In: Baum S. (ed.) Abrams’ angiography. 4th ed. Little, Brown and Company. Philadelphia,1997:1217-1229.  Back to cited text no. 10
    
11.
Bladimir, Saldarriaga, Sergio A, Pinto, Luis E, Ballesteros. Morphological Expression of the Renal Artery. A Direct Anatomical Study in a Colombian Half-caste Population. Int J Morphol. 2008;26 (1):31- 38.  Back to cited text no. 11
    
12.
Kornafel O, Baran B, Pawlikowska I. Analysis of anatomical variations of the main arteries branching from the abdominal aorta with 64 detectors computed tomography.Pol J Radiol. 2010 Apr;75(2):38-45.  Back to cited text no. 12
    
13.
Weld KJ, Bhayani SB, Belani J, Ames CD, Hruby G, Landman J. Extrarenal vascular anatomy of kidney: assessment of variations and their relevance to partial nephrectomy. Urology. 2005;66(5):985-989.  Back to cited text no. 13
    
14.
Bordei P, Sapte E, IliescuD, Dina C. The morphology and the surgical importance of the gonadal arteries originating from renal artery, Surg Radiol Anat. 2007; 29(5):367-371.  Back to cited text no. 14
    
15.
Sampaio FJ, Passos MA, Renal arteries: anatomic study for surgical and radiological practice. Surg Radiol Anat. 1992;14(2):113-117.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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