Accessory renal artery

A type II endoleak corresponds to the retrograde filling of the aneurysm mainly from lumbar arteries and/or IMA but also in rare situations from sacral, gonadal or accessory renal artery (Figs. 14.3,14.4). 

Segmental infarcts can also be due to segmental or reimplanted accessory renal artery thrombosis or be associated with acute rejection. They are usually... 

Fig. 23.4a-d. Multidetector CT evaluation in a potential renal donor. VR3D images, obtained in the multiple phases of renal enhancement, perfectly demonstrate (a) normal renal arteries with left accessory artery, (b) normal renal veins, (c) regular renal dimensions, morphology and parenchyma condition, and (d) normal collecting systems... 

Perforating arteries, an important collateral pathway to the kidney, arise from the intraparenchymal branches of the renal artery and exit from the kidney to anastomose with various retroperitoneal arteries [18]. In addition to the main renal artery and perforating arteries, the superior, middle, and inferior capsular arteries should be considered as well. The superior capsular artery may arise from the inferior adrenal artery, main renal artery, or aorta. The middle capsular artery, which may consist of one or more branches, arises from the main renal artery. The inferior capsular artery may originate from the gonadal artery, an accessory or aberrant lower pole, or even the main renal artery. These vessels form a rich capsular network that anastomoses freely with perforating arteries and other retroperitoneal (especially lumbar) arteries and also with internal iliac, intercostal, and mesenteric arteries [18]. 

The aorta and main renal arteries are routinely visualized during the early dynamic imaging phase. Accessory and crossing vessels are commonly seen, and the 3D images from early and late data sets can be superimposed to delineate the relationship of these vessels to the anatomic change in caliber (Fig. 1.2.9). Although UPJ obstruction related to crossing vessels is typically seen in older children, we often see... 

Computed tomographic angiography (Fig. 22.1) and magnetic resonance angiography (Fig. 22.2) both provide excellent images of the aorta and main renal arteries in children. Limitations of spatial resolution make it difficult to exclude stenosis of branch and accessory arteries, however, and further technical developments are required to overcome this problem. One possibility is that MR perfusion techniques may allow the indirect identification of RVD by identifying delayed perfusion of one kidney or a segment of kidney. 

In a recent study based on 94 renal donors, four-slice MDCT visualized 107 of the 114 renal arteries and 95 of the 98 renal veins confirmed at surgery, but 7 accessory arteries were missed in 6 donor kidneys, yielding respective MDCT sensitivities and specificities of 66% and 100%, 75% and 100%, and 50% and 100%, and overall accuracy of 94%, 97% and 99%, for the identification of variant anatomy of renal arteries, veins and ureters, respectively (Sahani et al. 2005). 

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