Multiple vascular variations at the vicinity of the left kidney

Although isolated variations of the renal artery, renal vein and testicular artery are commonly described in the literature, the concurrent presence of variations in all three of these vessels has seldom been reported. Here, we report concurrent vascular variations in the vicinity of the left kidney. The left renal vein was found to have a retropelvic tributary, and a communicating vein connecting the inferior vena cava and retropelvic tributary was also noted. In addition, the left renal artery separated into anterior and posterior divisions just before reaching the hilum. The anterior division further divided into two segmental branches which had a peculiar 'ram horn' shape. The posterior division of the renal artery entered the substance of the kidney without forming any further branches. The left testicular artery arose from the aorta above the level of the renal artery and then passed in front of left renal vessels following a tortuous course. The anatomical knowledge of this unusual vascular pattern may be useful during renal vascular reconstruction, treatment of renal artery stenosis, endoscopic surgeries and clinical evaluation of renovascular hypertension.