A case of novel combined variations of the renal and testicular vessels
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Abstract
Variations in the pattern of urogenital vessels can arise as a single occurrence or as a combination, which may increase the risk of unexpected injury during surgical procedures. Multiple variations in the renal and testicular vessels, in a novel combination, were observed during dissection of an 87-year-old Japanese male cadaver. In the present case, the patient had two renal arteries on each side. On the right side, the superior and inferior renal arteries emerged from the abdominal aorta at the L1 and L4 vertebrae levels, respectively. On the left side, the superior renal artery originated from the abdominal aorta at the level of the L1/L2 intervertebral disc, whereas the inferior renal artery arose at L4. The right testicular artery emerged from the abdominal aorta at the level of the L2 vertebra and crossed the inferior vena cava posteriorly. The venous system also exhibited some variations. The left renal vein passed posteriorly to the abdominal aorta and opened into the inferior vena cava at the level of the L2 vertebra. On the course to the inferior vena cava, the left renal vein was connected only to the first lumbar, azygos, and hemiazygos veins; blood was not collected from the left testicular and suprarenal veins, which usually open to the left renal vein. The patient had two right testicular veins. The lateral one opened into the angle between the right renal vein and the inferior vena cava at the level of the L2 vertebra, and the medial one drained into the inferior vena cava at a level slightly lower than the lateral one. Knowledge of the possible anatomical variations may be beneficial for performing safe retroperitoneal surgery and understanding the development of these vessels.
Keywords: anatomical variationrenal arteryrenal veintesticular arterytesticular vein
References
- Ahuja S, Maglasang N, Tan Y, et al. A unique case of extrarenal calyces and associated vascular variations in an adult female cadaver. Folia Morphol. 2022; 81(4): 1072–1078.
- Arathala R, Deshmukh V, S N, et al. A rare combination of genitourinary vascular anomaly. J Clin Diagn Res. 2018.
- Bass JE, Redwine MD, Kramer LA, et al. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics. 2000; 20(3): 639–652.
- Felix W. The development of the urogenital organs. In: Keibel F, Mall FP. ed. Manual of human embryology. J.B. Lippincott Company, Philadelphia : 752–880.
- Fernandes JR, Strufaldi MB, Machado B, et al. Bilateral Duplication of Gonadal Veins: a Case Report. Int J Morphol. 2012; 30(4): 1487–1489.
- Gupta R, Gupta A, Aggarwal N. Variations of gonadal veins: embryological prospective and clinical significance. J Clin Diagn Res. 2015; 9(2): AC08–AC10.
- Hoeltl W, Hruby W, Aharinejad S. Renal vein anatomy and its implications for retroperitoneal surgery. J Urol. 1990; 143(6): 1108–1114.
- Hostiuc S, Rusu MC, Negoi I, et al. Anatomical variants of renal veins: a meta-analysis of prevalence. Sci Rep. 2019; 9(1): 10802.
- Ichikawa T, Ono S, Nagafuji Y, et al. Congenital venous anomalies associated with retrocaval ureter: evaluation using computed tomography. Folia Morphol. 2023; 82(2): 300–306.
- Iwanaga J, Singh V, Takeda S, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Jetti R, Jevoor Ps, Vollala VR, et al. Multiple variations of the urogenital vascular system in a single cadaver: a case report. Cases J. 2008; 1(1): 344.
- Kitamura S, Sakai A, Yoshioka T, et al. [A rare case of the retroaortic renal vein (author's transl)]. Kaibogaku Zasshi. 1979; 54(4): 129–135.
- Kosuri KC, KS S, Nelluri V. Anomalous renal vasculature existing with congenital anomalies of kidneys, ureters and suprarenal glands: a cadaveric study. Ital J Anat Embryol. 2020; 124(3): 517–526.
- Kumar S, Neyaz Z, Gupta A. The utility of 64 channel multidetector CT angiography for evaluating the renal vascular anatomy and possible variations: a pictorial essay. Korean J Radiol. 2010; 11(3): 346–354.
- Kyung DS, Lee JH, Shin DY, et al. The double retro-aortic left renal vein. Anat Cell Biol. 2012; 45(4): 282–284.
- Macchi V, Parenti A, De Caro R. Pivotal role of the sub-supracardinal anastomosis in the development and course of the left renal vein. Clin Anat. 2003; 16(4): 358–361.
- Martinez-Almagro A, Almenar Garcia V, Martinez Sanjuan V, et al. Retroaortic left renal vein: a report of six cases. Surg Radiol Anat. 1992; 14(4): 361–366.
- Mazengenya P. Multiple variations of the renal and testicular vessels: possible embryological basis and clinical importance. Surg Radiol Anat. 2016; 38(6): 729–733.
- McClure C, Butler E. The development of the vena cava inferior in man. Am J Anat. 2005; 35(3): 331–383.
- Nallikuzhy TJ, Rajasekhar SS, Malik S, et al. Variations of the testicular artery and vein: a meta-analysis with proposed classification. Clin Anat. 2018; 31(6): 854–869.
- Nayak SB, Sirasanagandla SR, Shetty SD, et al. Multiple vascular variations at the vicinity of the left kidney. Anat Sci Int. 2013; 88(4): 230–233.
- Nayak SB, Kodimajalu Vasudeva S. Triple right testicular veins and their variant termination and communications. Heliyon. 2020; 6(9): e05014.
- Nidhi G, Amod D, Suniti P. Variations in testicular veins: An anatomico-clinical review. Gal Int J Health Sci Res. 2020; 5(2): 56–68.
- Okamoto K. The posterior renal vein (new definition), together with its morphological significance. Okajimas Folia Anat Jpn. 1990; 67(2-3): 203–217.
- Recto C, Pilia AM, Campi R, et al. Renal artery variations: a 20.782 kidneys review. Ital J Anat Embryol. 2019; 124(2): 153–163.
- Salimy MS, Luiselli GA, Yuen M, et al. A case of solitary kidney with duplex collecting systems and renal vascular variants in an adult male cadaver. Folia Morphol. 2021; 80(3): 722–725.
- Satyapal K. The renal veins: a review. Eur J Anat. 2003; 7(S1): 43–52.
- Stojadinovic D, Zivanovic-Macuzic I, Sazdanovic P, et al. Concomitant multiple anomalies of renal vessels and collecting system. Folia Morphol. 2020; 79(3): 627–633.
- Terayama H, Yi SQ, Naito M, et al. Right gonadal arteries passing dorsally to the inferior vena cava: embryological hypotheses. Surg Radiol Anat. 2008; 30(8): 657–661.
- Yang CY, Xue HG, Tanuma K, et al. Variations of the bilateral testicular veins: embryological and clinical considerations. Surg Radiol Anat. 2008; 30(1): 53–55.
