The National Ribat University

Faculty of Graduate Studies and Scientific Research

Variations of Renal Artery on CT Angiography in

Sudanese Patients

A thesis Submitted in Partial Fulfillment of the Requirements

for the Degree of MSc in Clinical Anatomy

By:

Amal Abdelbasit Fadle Elsid Mukhtar

Supervisor:

Dr. Mohmmed Ahmmed Abu Alnour

December 2014

اآلية

قال تعالى..

بسم اهلل الرحمن الرحيم

الهذي أنزل على عبده الكتاب ولم يجعل له عوجا )1( قيما لينذر بأسا شديدا من لدنه ويبشر الحمد لله

الحات أنه لهم أجرا حسنا )2( المؤمنين الهذين يعملون الصه

صدق اهلل العظيم

(2-1هف االية )سورة الك

Dedication

TO MY FATHER SOULE,WHO TAUGHT ME THAT THE BEST KIND OF

KNOWLEDGE.IT ALSO DEDICATED TO MY MOTHER ,HUSPEND, SON

FOR EVERYTHING.

Acknowledgement

First of all I thank Allah for giving me the strength and patience to do this work.

I would like to extend my sincere gratitude to the following people:-

My family thanks for your unending support, encouragement and sacrifices.

A big thanks to my supervisor Dr.MohmmedAhmmed Abo Alnour,, thank you for

your constant input and drive for making me see the bigger picture.

Finally thank you to all the patients who participated in this thesis, without you,

this dissertation could not have been possible.

List of Contents

Title Page

Quran…………………………………………………………………….1

Dedication……………………………………………………………... 11

Acknowledgement…………………………………………………… 111

Abstract (English)………………………………………………………1V

Abstract (Arabic)……………………………………………………….. V

List of Contents………………………………………………….V1&V11

List of Tables………………………………………………………...V111

List of Figures…………………………………………………………..IX

Chapter One

1. Introduction……………………………………………………………1

2. Objectives………………………………………………………..3

2.1 General objective………………………………………………3

2.2 specific objective………………………………………………3

Chapter Two

3. Literature Review……………………………………………………4

3.1Anatomy of the renal artery…………………………………………4

3.2Function of the kidney……………………………………………....7

3.3Development of the kidneys………………………………………...8

3.4Variation of the ranal arteries…………………………………….....10

3.5Using Radiographic technique…………………………………….12

Chapter Three

4. Materials and methods……………………………………….14

4.1. Area of study and duration…………………………………14

4.2Sample size …………………………………………………14

4.3data collection……………………………………………….15

4.4exclusion criteria……………………………………….....15

Chapter Four

5.1 Results………………………………………………………………16

Chapter Five

5.2 Discussion…………………………………………………………..23

Chapter Six

Conclusions and Recommendations

6.1 Conclusions…………………………………………………………25

Chapter Seven

References………………………………………………………………26

List of Tables

Table 1 ………………………....17

Table 2 ………………………....17

Table 3 ………………………....17

List of Figures

Figure 1normal figure of renal artery………28

Figure 2figure show the variation of the renal artery…………29

Abstract

The renal arteries play an important role in the circulatory system as they carry a

large portion of blood to the kidneys, and therenal artery variations are becoming

more important due to the gradual increase in interventional radiological

procedures, urological and vascular operations, and renal transplantation.

Variations inthe renal artery occur frequently and are of special interest to the

urologist. Aberrant renal arteries may produce a variety of urologic diseases and

their presence must be suspected particularly in patients with systemic

hypertension or proximal ureteral obstruction.

ملخص البحث

الكلخي، إلى الدم هي كبس جصء ححول أها كوا الدهىت الدوزة ف هاها دوزا حلعب الكلىت الشساي

اإلشعاعت، الخدخلت اإلجساءاث ف حدزجت لصادة ظسا أهوت أكثس أصبحج ، الشساى واالخخالفاث

بشكل ححدد الكلىي الشساى إحش ح االخخالفاث. الكلى وشزع الدهىت، واألوعت البىلت الوسالك وعولاث

هي هخىعت هجوىعت حخج قد الشاذة الكلىت الشساي. البىلت الوسالك لطبب خاص باهخوام وححظى هخكسز

أو الظاهت الدم ضغط ازحفاع هي عاىى الري الوسضى ف خاصت جىدهن شخبه أى وجب البىلت األهساض

.الدا الحالب اسداد

CHAPTER ONE

Introduction and Objectives

CHAPTER TWO

Literature Review

CHAPTER THREE

Materials and Methods

CHAPTER FOUR

Results

CHAPTER FIVE

Discussion

CHAPTER SIX

Conclusions and Recommendations

CHAPTER SEVEN

REFERENCES

APPENDIX

Introduction and Objectives

1.1. Introduction:

The superior urinary organs (kidneys and ureters) and their vessels are primary

retroperitoneal structures on the posterior abdominal wall that is; they were

originally formed as and remain retroperitoneal viscera. The kidneys produce urine

that is conveyed by the ureters to the urinary bladder in the pelvis1

Kidneys usually get their blood supply by the renal artery, arising from the aorta

and terminating in the kidney. The paired renal arteries take about 20% of the

cardiac output to supply an organ that represents less than one-hundredth of total

body weight.In most individuals, each kidney is supplied by a single renal artery

that originates from the abdominal aorta . The renal arteries typically arise from

the aorta at the level of L2 below the origin of the superior mesenteric artery, with

the renal vein being anterior to the renal artery. The renal arteries course anterior to

the renal pelvis before they enter the medial aspect of the renal hilum . The right

renal artery typically demonstrates a long downward course to the relatively

inferior right kidney, traversing behind the inferior vena cava. Conversely, the left

renal artery, which arises below the right renal artery and has a more horizontal

orientation, has a rather direct upward course to the superiorly positioned left

kidney. Both renal arteries usually course in a slightly posterior direction because

of the position of the kidneys.2

The main renal artery divides into segmental arteries near the renal hilum .The first

division is typically the posterior branch,which arises justbefore the renal hilum

and passes posterior to the renal pelvis to supply a large portion of the blood flow

to the posterior portion of the kidney. The main renal artery then continues before

dividing into four anterior branches at the renal hilum: the apical, upper, middle,

and lower anterior segmental arteries. The apical and lower anterior segmental

arteries supply the anterior and posterior surfaces of the upper and lower renal

poles, respectively; the upper and middle segmental arteries supply the remainder

of the anterior surface. The segmental arteries then course through the renal sinus

and branch into the lobar arteries. Further divisions include the interlobar ,arcuate,

and interlobular arteries3.

Depiction of the relatively avascular plane between the anterior and posterior

arterial divisions of the kidney is important to the surgeon, because the site can be

used for a clean incision toward the renal pelvis at the time of surgery. The site is

usually located posteriorly, one- third of the distance between the posterior and

anterior kidney surfaces. A similar a vascular plane exists between the posterior

renal segment and the polar renal segments4.

The frequency of renal diseases, and the increase of the need for renal transplants,

increase the need for research aimed at a better knowledge of the variations of the

blood vessels in the kidneys. The problem with transplantation is the lack of

available organs, and the increasing number of patients on the waiting lists leads

to increasing interest in live kidney donors. However, the presence of excessive

numbers of renal arteries results in technical limitations in kidney transplantation 5

.

The aim of this study was to determine the location of origins of renal arteries and

the variation rates of renal arteries in patients, whom underwent angiography for

the investigationof the renal vessels.

1.2. Objectives:-

1.2.1 General objective:

• To study the anatomical variations of the renal artery andto determine the risk

factor associated with the renal artery variations

1.2.2 Specific objectives:

To study the anatomical variations of the renal artery specifically concerning:-

• The variations of the level of origin of the renal artery.

• The variations of the termination of the renal artery.

• The variations of the segmental branches of the renal artery.

• The variations of the accessory renal artery.

2. Literature Review

2.1 Anatomy of the Renal Artery:

Classically, the description of a single renal artery arising from abdominal aorta

that supplies the respective kidney occursinlessthan25%ofcases. Common

variations of renal artery are its variable number and unusualbranching pattern6.

Variations in renal arteries have been called aberrant, supplementary, and

accessory, among otherterms.Weusedthe term supernumerary and analyze it in

accordance withMerklinclassification. We believe that prior knowledge of these

possible variations of renal arteries mayhelpthesurgeon in planning renal

transplantation, repair of abdominal aorta aneurysm, urological procedures,and

also for angiographicinterventions7.

Renal vascular segmentation was originally recognized by John Hunter in 1794,

but the first detailed account of the primary pattern was produced in the 1950s

from casts and radiographs of injected kidneys. Five arterial segments have been

identified. The apical segment occupies the anteromedial region of the superior

pole. The superior (anterior) segment includes the rest of the superior pole and the

central anterosuperior region. The inferior segment encompasses the whole lower

pole. The middle (anterior) segment lies between the anterior and inferior

segments. The posterior segment includes the whole posterior region between the

apical and inferior segments. This is the pattern most commonly seen, and

although there can be considerable variation it is the pattern that clinicians most

frequently encounter when performing partial nephrectomy. Whatever pattern is

present, it must be emphasized that vascular segments are supplied by virtual end

arteries. In contrast, larger intrarenal veins have no segmental organization and

Brödel (1911) 8described a relatively avascular longitudinal zone (the ‘bloodless'

line of Brödel) along the convex renal border, which was proposed as the most

suitable site for surgical incision. However, many vessels cross this zone, and it is

far from ‘bloodless': planned radial or intersegmental incisionsare preferable.

Knowledge of the vascular anatomy of the kidney is important when undertaking

partial nephrectomy for renal cell cancers. In this surgery the branches of the renal

artery are defined so that the surgeon may safely excise the renal substance

containing the tumour while not compromising the vascular supply to the

remaining renal tissue.

The initial branches of segmental arteries are lobar, usually one to each renal

pyramid. Before reaching the pyramid they subdivide into two or three interlobar

arteries, extending towards the cortex around each pyramid. At the junction of the

cortex and medulla, interlobar arteries dichotomize into arcuate arteries which

diverge at right angles. As they arch between cortex and medulla, each divides

further, ultimately supplying interlobular arteries which diverge radially into the

cortex. The terminations of adjacent arcuate arteries do not anastomose but end in

the cortex as additional interlobular arteries. Though most interlobular arteries

come from arcuate branches, some arise directly from arcuate or even terminal

interlobararteries .. Interlobular arteries ascend towards the superficial cortex or

may branch occasionally en route. Some are more tortuous and recurve towards the

medulla at least once before proceeding towards the renal surface. Others traverse

the surface as perforating arteries to anastomose with the capsular plexus (which is

also supplied from the inferior suprarenal, renal and gonadal arteries).

Afferent glomerular arterioles are mainly the lateral rami of interlobular arteries. A

few arise from arcuate and interlobar arteries when they vary their direction and

angle of origin: deeper ones incline obliquely back towards the medulla, the

intermediate pass horizontally, and the more superficial approach the renal surface

obliquely before ending in a glomerulus . Efferent glomerular arterioles from most

glomeruli (except at juxtamedullary and, sometimes, at intermediate cortical

levels) soon divide to form a dense peritubular capillary plexus around the

proximal and distal convoluted tubules: there are thus two sets of capillaries,

glomerular and peritubular, in series in the main renal cortical circulation, linked

by efferent glomerular arterioles. The vascular supply of the renal medulla is

largely from efferent arterioles of juxtamedullary glomeruli, supplemented by

some from more superficial glomeruli, and ‘aglomerular' arterioles (probably from

degenerated glomeruli). Efferent glomerular arterioles passing into the medulla are

relatively long, wide vessels, and contribute side branches to neighbouring

capillary plexuses before entering the medulla, where each divides into 12–25

descending vasa recta. As their name suggests, these run straight to varying depths

in the renal medulla, contributing side branches to a radially elongated capillary

plexus applied to the descending and ascending limbs of renal loops and to

collecting ducts. The venous ends of capillaries converge to the ascending vasa

recta, which drain into arcuate or interlobular veins. An essential feature of the

vasa recta (particularly in the outer medulla) is that both ascending and descending

vessels are grouped into vascular bundles, within which the external aspects of

both types are closely apposed, bringing them close to the limbs of renal loops and

collecting ducts. As these bundles converge centrally into the renal medulla they

contain fewer vessels: some terminate at successive levels in neighbouring

capillary plexuses. This proximity of descending and ascending vessels with each

other and adjacent ducts provides the structural basis for the countercurrent

exchange and multiplier phenomena .These complex renal vascular patterns show

regional specializations which are closely adapted to the spatial organization and

functions of renal corpuscles, tubules and ductsanstomose freely9.

2.2 Function of the kidney

Waste excretion: There are many things your body doesn’t want inside of it, and

the kidneys help get rid of some of them. The kidneys filter out toxins, excess salts,

and urea, a nitrogen-based waste created by cell metabolism. Urea is synthesized in

the liver and transported through the blood to the kidneys for removal.

Water level balancing: As the kidneys are key in the production of urine, they

react to changes in the body’s water level throughout the day. As water intake

decreases, the kidneys adjust accordingly and leave water in the body instead of

helping excrete it.

Blood pressure regulation: The kidneys need constant pressure to filter the blood.

When it drops too low, the kidneys increase the pressure. One way is by producing

a blood vessel-constricting protein (angiotensin) that also signals the body to retain

sodium and water. Both the constriction and retention help restore normal blood

pressure.

Red blood cell regulation: When the kidneys don’t get enough oxygen, they send

out a distress call in the form of erythropoietin, a hormone that stimulates the bone

marrow to produce more oxygen-carrying red blood cells.

Acid regulation: As cells metabolize, they produce acids. Foods we eat can either

increase the acid in our body or neutralize it. If the body isto function properly, it

needs to keep a healthy balance of these chemicals. The kidneys do that, too10

2.3Development of the Kidneys:-

Three sets of kidneys develop in human embryos. The first set-the pronephroi-is

rudimentary, and the structures are never functional. The second set-the

mesonephroi-is well developed and functions briefly. The third set-the

metanephroi-becomes the permanent kidneys.

2.3.1 .Pronephroi

These bilateral transitory, nonfunctional structures appear in human embryos early

in the fourth week. They are represented by a few cell clusters and tubular

structures in the neck region . The pronephric ducts run caudally and open into the

cloaca. The pronephroi soon degenerate; however, most of the length of the

pronephric ducts persists and is used by the next set of kidneys.

2.3.2 .Mesonephroi

These large, elongated excretory organs appear late in the fourth week, caudal to

the rudimentary pronephroi. The mesonephroi are well developed and function as

interim kidneys for approximately four weeks, until the permanent kidneys develop

. The mesonephric kidneys consist of glomeruli and tubules . The mesonephric

tubules open into bilateral mesonephric ducts, which were originally the

pronephric ducts. The mesonephric ducts open into the cloaca. The mesonephroi

degenerate toward the end of the first trimester; however, their tubules become the

efferent ductules of the testes. The mesonephric ducts have several adult

derivatives in males .

2.3.3 .Metanephroi

Metanephroi-the primordia of permanent kidneys-begin to develop early in the

fifth week and start to function approximately 4 weeks later. Urine formation

continues throughout fetal life. Urine is excreted into the amniotic cavity and

mixes with the amniotic fluid. A mature fetus swallows several hundred milliliters

of amniotic fluid every day, which is absorbed by its intestines. The fetal waste

products are transferred through the placental membrane into the maternal blood

for elimination by the maternal kidneys. The permanent kidneys develop from two

sources :

The metanephric diverticulum (ureteric bud)

The metanephrogenicblastema or metanephric mass of mesenchyme11

2.4 Variation of the Renal artery:-

renal artery variations are common in the general population and

the frequency of variations shows social, ethnic, and racial differences . It is more

common in Africans (37%) and Caucasians(35%),and is less common in Hindus

(17%) and the populations except Caucasians (18%). The frequency of extra renal

arteries (ERA) shows variability from 9% to 76% and is generally between 28%–

30% in anatomic and cadaver studies .Renal artery variations are becoming more

important due to the gradual increase in interventional radiological procedures,

urological and vascular operations, and renal transplantation .

Renal artery variations are divided into 2 groups: early division and

ERA. Branching of the main renal arteries into segmental branches more

proximally than the renal hiluslevel is called early division. ERA is divided into 2

groups:Hilar (accessory) and polar(aberrant) arteries.

Hilar arteries enter kidneys from the hilus with the main renal artery, whereas polar

arteries enter kidneys directly from the capsule outside the hilus.

The arteries play an important role in the circulatory system as they carry a large

portion of blood to the kidneys. Narrowing ofthe renal arteries (stenosis) may

result in hypertension. The arteries may also be affected by diseases such as

aneurysm and atherosclerosis which usually cause alteration in their luminal

diameter12

There are cases though when more than one renal artery can be found. The first

systematic attempt to study the frequency of occurrence of renal vascular

variations was that under taken by the Anatomical Society of Great Britain and

Ireland as far back as 1890 .The term «additional renal artery» was first established

by Satyapal;and by replacing terms like «accessory», «aberrant», «anomalous»

,«supernumerary», «supplementary» and «multiple», it was used as a more

comprehensive expression in describing renal arteries, other than

the main one Additional renal arteries are not uncommon; they appear in

about 25 to 30% of the general population and represent persistence of

the embryonic pattern It is important to remember that renal arteries end

arteries, that do not intra renally anastomose each one feeds only a segment of

the kidney’s parenchyma. Because of that the occlusion or

obstruction the blood flow in one of them may cause segment ischaemia

with subsequent hypertension. On the contrary, veins do anastomose and that

is variations of the veins are not so important and tied

Additional arteries may be equally or differently

Distributed between the two kidneys. Addition veins are more common on the

right kidneythey do not necessarily correspondto the number the arteries. The

incidence of additional renal arteries, vary cording to the ethnic origin of the

individual Indians show an incidence of

17.4%,coloured18.5%,Caucasians35.3%and the Africans as high as 37.1%.A

thorough knowledge of the variations of the renal artery has grown in importance

with the increasing numbers of renal transplants. The literature indicates, That

multiple renal arteries are found in 9-76% cases.

Variations in the origin and course of the renal arterial blood supply occur

frequently and are of special interest to the urologist. Aberrant renal arteries may

produce a variety of urologic diseases and their presence must be suspected

particularly in patients with systemic hypertension or proximal ureteral

obstruction13

2.5. UsingRadiographic technique:-

Multidetector computed tomography angiography (MDCTA)plays an increasingly

important role in the evaluation of the renal vasculature . Although conventional

angiography is still regarded as the gold standard in renal vascular imaging,

MDCTA is increasingly used as it is less invasive, easily applicable and available .

MDCTA enables precise visualization of the normal and variant anatomy of

several regions including the renal vasculature ; however, the main drawbacks of

MDCTA are the exposure to ionizing radiation and

the use of potentially nephrotoxic iodinated contrast material. As such, its use is

limited in children and pregnant women and in patients with impaired renal

function.14

Main clinical indications for renal MDCTA include the imaging workup for ruling

out renovascular hypertension, renal transplant recipient and donor evaluation,

acute onset flank pain in

patients with coagulativedisorders, direct renal trauma, arteriovenous

communications, renalartery aneurysm, renalparenchymal or vascular

calcifications, renalmanifestations of a systemic disease (e.g., vasculitis,

thromboembolic disease)

.15

Digital subtraction angiography (DSA) is regarded as the gold standard in the

evaluation of vascular structures, although its invasive nature significantly limits

its role. In recent years, the introduction of multidetector CT (MDCT) and its

ability to image vascular structures of small diameter have led to a significant

reduction in the utilisation of invasive DSA examinations16

3. Materials and Methods

3.1.Design :-

This is a cross sectional study.

3.2. study Area:-

Will be conducted in Khartoum state (Renal Flair Center).

3.3. study population :-

All individuals under studding in Khartoum state (Renal Flair Center).

3.4. study duration

This study will be conducted in between ( October to December 2013 )

3.5. Selection criteria

All patients who underwent CT angiography of the renal artery and its branches for

various reasons in(renal flair center) from date through were investigated

retrospectively.

3.6.Inclusion criteria

All individuals in Khartoum state which come to(renal flair center).

3.7.Exclusion criteria

All individuals in Khartoum state which come to(renal flair center) for many

causes pathological or tecqunical status out angiography.

3.8. Method of collection data

Data will be collected by using:-

1- Photos Radiology.

2-Clinical report.

3- Questioner.

3.9. Data analysis :-

The collected data was analyzed with Computer program SPSS version 16.0. The

mean and standard deviation were estimated for quantitative data and frequency

and % were calculated for qualitative data. The results presented in shape of tables

and figures.

3.10. Ethical approved :-

All the samples collected after approved of the individuals under study.

4. Result

This study included 30 individual( male 14 and female 16),The variation of the

renal arteries in the Sudanese patients show different result which classify as:

Regarding the associations of renal artery variations with the gender: in the female

the variations of the renal artery is (68.2%)and the number of samples is (30) and

in males the renal artery variations was (31.8%) , the number of samples is (

14).(Fig ). Regarding the associations of renal artery variations with the body

sides: the variations of the renal artery is (56.3%) and the number of samples is

(16) on the right side, and the renal artery variations was (43.8%) , the number of

samples is (16 ) on the left side.(Fig ).

Regarding the branching of renal arteries:Hilar branching in (16) samples(43.8%)

Fig 1, Prehilar branching in ( 16) samples(18.8%). Fig 3 right side

Regarding the presence of accessory renal artery(ARA): ARA was found in (3 )

samples(18.8%), (3 ) samples on the right side.&( 18.8%) samples on the left side.

Fig 3

Regarding the prevalence of unilaterality or bilaterality of accessory renal arteries

(ARA): Unilateral in 7 specimens (11.67%) Fig 2, 4 & 5, Bilateral in 4 specimens

(6.67%). Fig 1

Regarding the type of accessory renal arteries (ARA): Superior polar arteries

(SPA) are 5(6.67%) Fig 1 left side, Inferior polar arteries(IPA) are 6(10%) Fig 2 &

3 left side, Hilar arteries are 7(11.67%). Fig 4

Prevalence of type of accessory renal artery (ARA) on right side: superior polar

arteries-1(3.33%), inferior polar A-2(6.67%), hilar arteries-4(13.33%). Prevalence

of type of accessory renal artery (ARA) on left side: superior polar A-3(10%),

inferior polar A-4(13.33%), hilar A-3(10%).

Source of origin of ARA: Aorta-12 out of 17(20%) Fig 1, 2 & 3, Main RA-5 out

of 17(8.33%) Fig 4 & 5, none from the common iliac artery or the bifurcation of

aorta.

Source of origin of different types of ARA: From Aorta-12, out of which 2

superior polar A, 5 inferior polar A, 5 hilar A. From Main Renal artery -5, out of

which 2 Superior polar A, 1 Inferior polar A, 2 hilar artery.

Table 1 shows descriptive statistics of variation of renal artery in relation with

gender of patient male or female.

Table 2 shows descriptive statistics of percentage of people come to the clinical

center for renal angiography or other angiography for different part of the body.

Table 3 shows descriptive statistics of Number of the prevalence of unilaterality or

bilaterality of accessory renal arteries

Table 1:- Number of Cases by Gender

Male Female

14 16

Table 2:- Number of the associations of renal artery variations with the body

sides

Left Right

43.8% 56.3%

Table 3:-Number of the prevalence of unilaterality or bilaterality of accessory

renal arteries

Bilateral Unilateral

6.67% 11.67%

Figure-5.3: shows descriptive statistics of percentage of people come to the

clinical center for renal angiography or other angiography for different part of the

body.

Figure-5.3: Distribution of the study sample depending of side of the body

Figure-5.3: Distribution of the study sample Depending on Type of variation

Figure-5.3:show the variations of the renal artery

Figure 1normal figure of renal artery

Figure 2figure show the variation of the renal artery accessory renal artery on left

side.

5-Discussion

5-Discussion:-

The kidneys, which are located inside the pelvis during the embryological period,

obtain their blood supply from blood vessels in that region. Initially, the renal

arteries take their origin from the common iliac arteries. As the kidneys ascend,

blood supply is obtained from the distal end of the aorta1. When they ascend

further, the kidneys receive blood from new aortic branches. As the kidneys reach

their final destination, they are fed by true permanent renal arteries from the

abdominal aorta and the previous caudal renal feeders undergo involution. The

wide variations observed in the kidneys’ blood supply are the result of these

changes in the organs’ blood supplies during embryological and early fetal life12

.

Therenal artery variations are becoming more important due to the gradual increase

in interventional radiological procedures, urological and vascular operations, and

renal transplantation17

.

In our study, the renal artery and its variations were demonstrated very well by CT

renal angiography, and the variations were study inrelation to the gender, the body

side, and the common type of therenal artery variations.

The results of this study revealed that the variation of the renal artery is more

common in female than in male, also this study show the percentage of the normal

patients is greater than the variation.

In addition to that there is no significant differences between the side of the body

in relation of variation, the study show the segmental artery is common type of

variation, also this study showthe percentage is equal in relationbetween the

variation according to the present of the accessory renal artery and the variation

according to the distant of origin from the aorta.

The aim of this study was be used in different country to determine the location of

origins of renal arteries and the variation rates of renal arteries in patients, whom

underwent angiography for the investigation of the renal vessels.

6-Conclusion and Recommandation

6.1. Conclusion :-

Identification of renal vascular variants is important, especially before laparoscopic

donor or partial nephrectomy and vascular reconstruction for renal artery stenosis

or abdominal aortic aneurysm.

angiography is an excellent imaging investigation because it is a fast and

noninvasive tool that provides highly accurate and detailed evaluation of normal

renal vascular anatomy and variants. The number, size and course of the renal

arteries and veins are easily identified by angiography.

6.2. Recommendations:-

Larger number of population is needed in further studies .

Study the renal artery in different subpopulation group.

New methods can be used to study renal artery.

7. References

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Ed., London,Elsevier, Churchill Livingstone. 2005;1118,1121,1274,1276.

2. Moore kL,Persaud TVN. The Devloping Human:Clinically Oriented

Emberyology.8th

Ed.,Philadelphia,Saunders,Elsevier.2008;249-251

3. Davies, D. V. In Gray's Anatomy. Descriptive and Applied, 34rd ed. (Orient

Longmans). (1969): 67 (16): 2773–86.

4. Bruce A. Urban, MD,Lloyd E. Ratner, MD,Elliot K. Fishman, MD . Three-

dimensional Volume-rendered CT Angiography of the Renal Arteries and Veins:

Normal Anatomy, Variants, and Clinical Applications, RadioGraphics;

2001,21:373–386

5.Elvira Talovic, ,Review of the supernumerary renal arteries by dissection

method, 2007. 11 (3): 480–96

6.VirendraBudhiraja, Supernumerary Renal Arteries and Their Embryological

and Clinical Correlation: A Cadaveric Study from North India 2007; 44: 1462 –

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7. G. Timothy Johnson, M.D "Arteriograms, Venograms Are Angiogram

Territory". Chicago Tribune. Retrieved 12 September 2011.

8.Verma R, Kalra S, Rana K. Malformation of Renal and Testicular Veins–

A case Report. J. Anat. Soc. India. 2005;54(1):29–31.

9.Max Brödel was a medical illustrator(June 8, 1870 – October 26, 1941) .

10.variation of renal artery on ,www.elsevier-etextbooks.com/reader/grays

www.healthymagination.comon ,variation of renal artery .11

12.KEITH L. MOOR,T.V.N PERSAUD ,Clinically Oriented emberylogy ,8th

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