Multiple renal artery

The renal arteries originate from the aorta at the L2 level. A third of the population has multiple renal arteries. The main renal arteries are 5 to 6 mm in diameter and typically bifurcate into anterior and posterior divisions. There is further subdivision into segmental, interlobar, arcuate, and interlobular arteries before termination in glomeruli. Capsular and adrenal arteries take their origin from the main renal arteries. 

Variant anatomy of the ovarian arteries includes the gonadal artery originating from the renal artery in about 20% of individuals [2]. Very rarely the artery arises from the adrenal, lumbar, or iliac arteries [2]. In some cases, the right ovarian artery passes behind the cava and over the right renal vein. The left ovarian artery will occasionally also pass over the left renal vein [2], There is very rarely a common trunk of left and right gonadal arteries, and occasionally there are multiple gonadal arteries. 

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... 

The renal graft itself can also be involved. Most of the time, the lesion develops within the renal hi-lum, infiltrating the perirenal fat and encasing renal arteries and veins (Fig. 3.40). The tumor tissue may spread into the sinus, then into the renal parenchyma or towards the perirenal fat. Less often, renal involvement resembles multiple renal nodules. Involvement of the native kidneys and the bladder is also possible (Bellin et al. 1995). 

There is epidemiologic evidence to suggest an increased prevalence of duodenal ulcers in patients with certain chronic diseases, but the pathophysiologic mechanisms of these associations are uncertain. A strong association exists in patients with systemic mastocytosis, multiple endocrine neoplasia type 1, chronic pulmonary diseases, chronic renal failure, kidney stones, hepatic cirrhosis, and ai-antitrypsin deficiency. An association may exist in patients with cystic fibrosis, chronic pancreatitis, Crohn s disease, coronary artery disease, polycythemia vera, and hyperparathyroidism. 

K/DOQI Kidney Dialysis Outcomes and Quality Initiative MAP mean arterial blood pressure MDRD Modification of Diet in Renal Disease MRFIT Multiple Risk Factor Intervention Trial NHANES III Third National Health and Nutritional Examination Survey... 

Multiple neuroendocrine and metabolic finks exist between arterial hypertension and hypothyroidism. Metabolic and neuroendocrine alterations may be associated with arterial hypertension, inducing both adjunctive cardiovascular risk and vascular, cerebral, renal and cardiac pathologies (so-called hypertensive target organ damage ). A hypothyroid dysfunction may interact with all these factors and conditions. 

The ovarian artery originates from the lumbar aorta near the renal hilum. It is accompanied along its retroperitoneal course by the ovarian vein and the ureter on the anterior surface of the psoas muscle. It then crosses the ureter and common iliac vessels near the pelvic brim to enter the suspensory ligament of the ovary. The ovarian artery courses inferiorly and medially between the two layers of the broad ligament near the mesovarian border [4]. It forms multiple branches that reach the ovarian hilum via the mesovarium. It has a tortuous course that is most pronounced near the ovary. 

Chronic renal failure is also frequently associated with diminished erectile function, impaired libido, and infertility. The mechanism is probably multifactorial low serum testosterone concentrations, diabetes mellitus, vascular insufficiency, multiple medications, autonomic and somatic neuropathy, and psychological stress. Men with angina, myocardial infarction, or heart failure may have erectile dysfunction from anxiety, depression, or concomitant penile arterial insufficiency. 

In patients with high-flow priapism and complex traumas undergoing contrast-enhanced CT with state-of-the-art multiple detector-row systems, the arterial-sinusoidal fistula can he identified (Fig. 10.8). This examination, however, cannot replace angiography, because interventional maneuvers cannot be performed. In malignant priapism contrast-enhanced CT is indicated to evaluate the perineal and pelvic extent of the disease. In patients with priapism secondary to aortocaval fistula contrast-enhanced CT reveals the communication between the aorta and the inferior vena cava and congestion of the pelvic vessels (Abela et al. 2003 Gordon et al. 2004). Poor enhancement of the kidneys reveals renal hypoperfusion. 

Extrinsic compression on the colon can result from multiple structures such as the iliac vessels, liver, renal masses, and stomach (Macari and Megibow 2001). Compression by one of the iliac arteries is a relatively common finding, and results in a linear extrinsic compression on the sigmoid colon (Fig. 14.21). 

Some advanced or superficial tumors may parasitize arterial supply from the arteries of adjacent organs, especially after multiple prior embolization procedures. Such parasitization may require embolization of branches arising from such arteries as the right renal, colonic, gastric, phrenic, internal thoracic, and intercostal arteries. It is important to recognize that not all such parasitized vessels can be safely treated without risk to other important organs. 

The arterial axis is first palpated to evaluate the quality of its wall. Arterial and venous dissection is limited to segments to be used for anastomoses. In most cases, the renal vein is attached to the external iliac vein. The arterial anastomosis is more variable end-to-side to the external iliac, most often above the venous implantation, or to the primary iliac artery sometimes end-to-end to the hypogastric artery, when taken from a living donor, because the graft s artery does not have an aortic patch. All these sites can be used in combination when multiple arteries are reimplanted, even the epigastric artery for the small isolated polar branches. 

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