Multiple Renal Vessels: The Anatomical Variants with Clinical Implications in Renal Interventions and Hypertension

A comprehensive knowledge of renal vasculature is essential to diagnose and carry out safe clinical interventions accurately. Anatomic variations in renal vessels can present procedural challenges in surgeries such as nephrectomy, transplants, and endovascular interventions.

In the present retrospective study, we analyzed the distribution patterns of the renal vascular variants and measurements of length and diameter in computed tomography angiographies (CTAs). The study evaluated renal arteries and veins in 400 kidneys from 200 CTA scans performed for various clinical indications. Two trained team members did the evaluation independently, followed by statistical analysis.

The study's results revealed the presence of multiple renal arteries (multiRAs)/accessory renal arteries in 24.5% of left and 17.5% of right kidneys, with a total of 29% with at least one multiRA on one side. The prevalence of specific types of renal arteries per respective left and right kidney were as follows: accessory arteries entering hilum- 23.5% and 16.5%, hilar artery with early bifurcation - 6% and 5%, polar arteries - 4.5%, and 2.5%, extra-hilar polar branches - 0.5% and 5%, extrahilar presegmental branches - 45% and 54%. The total frequency of multiple renal veins was 1.5% in the left and 14.5% in the right kidneys. Retroaortic and circumaortic left renal vein frequency constituted 1%.

Awareness of the variant anatomy of renal vasculature is important to optimize the surgical strategies during endovascular interventions and kidney transplantation and to minimize the risks of intra and postoperative complications.