Variations of Renal Artery on CT Angiography in Sudanese...
Transcript of Variations of Renal Artery on CT Angiography in Sudanese...
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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