Renal artery variations in renal transplantation and their importance

1. By
BADMUS A.M

2.  Introduction
 Epidemiology
 Normal Anatomy
 Types of variations
 Effect of variations on transplanted kidney
 Conclusion

3.  Kidney develop in 3 stages (pronephros,
mesonephros and metanephros ).
 Ascend from the pelvis to lumbar region with
change in blood supply.
 Accessory renal artery arise from the
abdominal aorta either above or below the
main renal artery.

4.  Accessory arteries are end arteries, therefore
there will be ischemia if it is damaged.
 Accessory arteries are end arteries.
 “Accessory” is misleading.
 With the advent of donor nephrectomy or
laparoscopic renal surgery, its mandatory to
understand the variations.

5.  Anatomic variations in the renal vasculature
occur in approximately 25-40% of patients.
 Male : Female is 1:1
 Multiple renal arteries is the commonest type

6. Between transverse processes of
T12-L3, left kidney more
superior than right, upper poles
oriented medially/posteriorly

9.  Multiple renal arteries:
Right: 32%
Left: 32%

10. Multiple Renal arteries

12.  Pre-hilar Segmental branches : 17%
 Stenosis of renal artery at origin 2%
 Fetal lobulation 4%
 Universal disparity in size 1.2%
 Fibromuscular dysplasia: 2%
 Microaneurysm 0.5%
 Dromedary hump 0.5%
 True aneurysm 1%
 Lipogranulomatous 0.5%
 Multiple finding 3.5%

15.  Sampaio FJ, Novick AC, Nghiem, Benoit
 Various studies in different centres and time
showed no significant different between single
renal artery and multiple arteries.

16.  An anatomical knowledge on the pattern of
the renal hilar structures is of paramount
importance for various urological procedures
.

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In: Novick AC, Straffon RA (eds.), Vascular Problems in Urologic
Surgery. Philadelphia, W.B. Saunders. 1982; pp. 233-44.
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