Three-dimensional analysis of renal artery bending motion during respiration

To evaluate displacement and bending of the renal arteries during respiration.

Seven men (mean age 59+/-7 years, range 54-71) were imaged with contrast-enhanced magnetic resonance angiography (MRA). Two phases of the MRA were acquired during separate normal inspiration and expiration breath-holds. Displacement of the kidneys and renal ostia and changes in renal branch angle were measured in both coronal and axial views. Arterial curvature and distances between inspiration and expiration renal artery centerlines were computed at 1-mm intervals for the first 2 cm of each branch.

Significant kidney displacement was observed in both the coronal and axial views, with maximum displacement on the right side; the right kidney at expiration was 13.2+/-7 mm superior and 6.3+/-3.4 mm posterior of its position during inspiration. By comparison, the renal ostia were relatively fixed, displacing 10-fold less than the kidneys. This displacement differential resulted in significant renal branch angle changes between inspiration and expiration, with the branches being more perpendicular at expiration. Right and left branch angles were significantly different from each other in the axial view, with the right artery taking off more anteriorly. The renal artery centerlines were displaced approximately 2.5 mm at a distance of 1 cm from the ostia, with little displacement change in the second centimeter. The right renal artery was more curved than the left, with more respiratory-induced curvature change near the ostia.

Positional change of the kidneys during respiration induces both bending and change in angulation of the renal arteries. This bending can have a complex 3-dimensional shape near the ostia. In the setting of renal artery stenting, this motion may adversely affect the artery and/or the stent, possibly contributing to restenosis.