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CASE REPORT
Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 75-77

A peculiar accessory renal artery giving origin to the left testicular artery


Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Madhav Nagar, Manipal, Karnataka, India

Date of Web Publication13-Jun-2014

Correspondence Address:
Srinivasa Rao Sirasanagandla
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Madhav Nagar, Manipal 567 104, Karnataka
India
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DOI: 10.4103/1118-8561.134488

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  Abstract 

The occurrence of the accessory left renal artery (ALR) and its giving origin to the left testicular artery (LTA) is not a common variation. We report a rare type of course and branching of an ALR which was observed in an approximately 65-year-old male cadaver of the Indian origin. The left kidney (LK) was supplied by two renal arteries (RA). The main RA arose from the abdominal aorta (AA) and then reached the LK by passing above the renal vein. It gave three segmental branches before entering into the hilum. The ALR was smaller in size than the main RA and it arose from the AA below the level of the main RA. It hooked around the left renal vein (LRV) and entered into the hilum without branching, passing posterior the renal vein. ARA presented a peculiar S shape in its course. Further, the ALR gave origin to LTA at its middle segment. The LRV was normal in formation, course and drainage. Knowledge of the unusual perihilar vascular variations of the kidney is of significance during the radiologic and angiographic and surgical procedures.

Keywords: Accessory renal artery, left testicular artery, left kidney


How to cite this article:
Nayak SB, Sirasanagandla SR, Shetty SD, Swamy RS. A peculiar accessory renal artery giving origin to the left testicular artery. Sahel Med J 2014;17:75-7

How to cite this URL:
Nayak SB, Sirasanagandla SR, Shetty SD, Swamy RS. A peculiar accessory renal artery giving origin to the left testicular artery. Sahel Med J [serial online] 2014 [cited 2021 Jun 19];17:75-7. Available from: https://www.smjonline.org/text.asp?2014/17/2/75/134488


  Introduction Top


Renal arteries (RA) frequently show variations in their number and branching pattern. [1] Classically, each kidney receives single RA from the abdominal aorta (AA). At the hilum each RA divides into 4-5 segmental branches. [2] The kidney may receive an extra RA arising from AA in addition to the main RA and such artery is frequently termed as accessory RA. [3] The additional RA supplying the kidney may also arise from sources other than the AA, which is termed as aberrant artery. [3] Occurrence of accessory RA is not uncommon with an of 30%. [4] Accessory RA may arise either above or below the main RA. Accessory RA is due to the persistence of the lateral splanchnic branches of the primitive aorta. [5]

The Origin of the left testicular artery (LTA) from the RA or accessory RA is not a common variation. [6],[7] We report a rare case of origin of the LTA from the accessory left renal artery (ALR) and the peculiar course of the ALR in relation with the left renal vein (LRV). The clinical significance is discussed.

During regular dissection classes for medical undergraduates, we observed a rare vascular variation at the perihilar region of the left kidney (LK) in an approximately 55-year-old male cadaver of the South Indian origin. The LK was supplied by two RA. The main left RA after arising from the AA, with a tortuous course ran laterally above the LRV and divided into three segmental branches before entering into the hilum of the kidney [Figure 1]. The accessory RA arose from the AA below the level of the normal left RA. It was small in size when compared to the main RA. ALR presented a peculiar "S shape" course around the left RA. It entered into the hilum of the kidney without branching, by passing behind the LRV [Figure 1] and [Figure 2]. Further, the LTA took origin from the middle segment of the ALR [Figure 1] and [Figure 2]. The LRV was normal; it was formed at the hilum by two tributaries and finally drained into the inferior vena cava.
Figure 1: Dissection of the perihilar region of the left kidney (LK) showing the accessory renal artery giving origin to the left testicular artery. Note the tortuous course of the left renal artery and its point of entry into the hilum of LK. (Left testicular vein, left renal vein, inferior mesenteric vein, abdominal aorta, superior mesenteric artery, pancreas)

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Figure 2: Dissection of the perihilar region of the left kidney showing the peculiar S shaped course of the accessory renal artery (AR) and its origin from the abdominal aorta (AA). Origin of the left testicular artery from the AR is also seen. (Left renal vein, segmental branches of the left renal artery, inferior mesenteric
vein, AA, superior mesenteric artery)


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  Discussion Top


In the present case, the LK was supplied by two RA. We described the additional smaller artery as an accessory RA. Occurrence of the accessory RA has been reported frequently. Bordei et al. in their study, observed double RA arising from the AA in 19.85% of cases. [8] In a study by Janschek et al., multiple arteries were observed with incidence rates of 20.2% on the right and 19% on the left side. [9] In another study by Saldarriaga et al., the incidence of the single additional RA was found to be 43.5% and 56.3% on right and left sides, respectively. [10] Budhiraja et al. in their study on 50 formalin fixed cadavers reported the additional RA in 8.33% of cases. [11] In their study, the frequency of the duplication of RA was found to be more on the right side (62.5%) than the left side (37.5%). [11] Further, the accessory RA may occur unilaterally or bilaterally. [12] In a study by Ankolekar and Sengupta, the bilateral occurrence of accessory RA was observed in 6.7% of cases and unilateral occurrence in 11.7% of cases. [12] Persistence of some of the lateral splanchnic branches that supply the primitive kidney during its ascent results in the formation of the accessory RA. [5] The embryonic signals that are involved in the accessory RA persistence are yet to be evaluated. [6]

In the present case, ALR hooked around the LRV and presented peculiar "S shape" before entering into the hilum. The normal RA with tortuous course ran in front of the LRV and divided into three segmental branches, before entering into the hilum of the LK. This knowledge of unusual course presented by the two arteries, in relation to the LRV may be of clinical significance during the renal transplantation and interventional surgical procedures in the perihilar region. Earlier Nayak et al. have reported a case of "ram horn" shaped segmental branches of the left RA. [13] Awareness of perihilar branching pattern of the segmental branches is crucial while planning the selective clamping of the segmental branches. It is also necessary to minimize renal ischemic injuries. [14] Further, the knowledge of the peculiar course of the RA as reported in the current case is clinically important while performing renal vascular reconstruction, in the treatment of RA stenosis, during endoscopic surgeries and clinical evaluation of renovascular hypertension. [15] Testicular artery (TA) may take unusual origin from the middle suprarenal artery, superior suprarenal artery, one of the lumbar arteries, RA, accessory RA, superior epigastric artery and common or internal iliac artery. [16] The anatomic variations of the TA are classified into four types by CiηekcibaΊi et al. [17] In type I, the TA arises from the suprarenal artery; in type II, the TA takes origin from the RA; in type III, the TA takes origin at higher from the AA, near to the RA lineage; in type IV, the TA is duplicated and arises from the AA or from the other vessels. [17] TA artery observed in the present case belongs to type II classification. In a study by Pai et al., the anatomical variation of TA has been found in 4.7% of cases. [6] Filipovic et al. have described a case of double LTA; one of which originated from the left accessory RA while the other one originated from the common trunk with left inferior suprarenal artery. [7] In the current report the TA originated from the left accessory RA before entering into the hilum of the LK. Siniluoto et al. reported a case in which transcatheter embolization of a malignant left renal tumor with absolute ethanol resulted in the infarction of the left testis. [18] Origin of the left TA from the RA or its branches could be the possible reason for the infarction of the left testis. [18] Therefore, prior examination of the perihilar vascular structures may reduce the post-surgical complications.

 
  References Top

1.Budhiraja V, Rastogi R, Anjankar V, Ramesh Babu CS, Goel P. Supernumerary renal arteries and their embryological and clinical correlation: A cadaveric study from North India. ISRN Anat 2013; Doi.org/10.5402/2013/4057.  Back to cited text no. 1
    
2.Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, et al. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Edinburgh: Churchill and Livingstone; 2008. p. 1231-3, 1262-3.  Back to cited text no. 2
    
3.Graves FT. The aberrant renal artery. J Anat 1956;90:553-8.  Back to cited text no. 3
    
4.Standring S, Ellis H, Healey JC, editors. Gray's Anatomy. The Anatomical Basis of Clinical Practice. London: Elsevier-Churchill Livingstone; 2005. p. 1274.  Back to cited text no. 4
    
5.Bannister LH, Berus MM, Collins P, Dyson M, Dusek JE, Ferguson MW. Grays Anatomy. Edinburgh: Churchill Living Stone; 2008. p. 1225-33.  Back to cited text no. 5
    
6.Pai MM, Vadgaonkar R, Rai R, Nayak SR, Jiji PJ, Ranade A, et al. A cadaveric study of the testicular artery in the South Indian population. Singapore Med J 2008;49:551-5.  Back to cited text no. 6
    
7.Filipovic B, Stijak L, Filipovic B. An unusual origin of the double left testicular artery in a male cadaver: A case report. J Med Case Rep 2012;6:267.  Back to cited text no. 7
    
8.Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surg Radiol Anat 2004;26:474-9.  Back to cited text no. 8
    
9.Janschek EC, Rothe AU, Hölzenbein TJ, Langer F, Brugger PC, Pokorny H, et al. Anatomic basis of right renal vein extension for cadaveric kidney transplantation. Urology 2004;63:660-4.  Back to cited text no. 9
    
10.Saldarriaga B, Pérez AF, Ballesteros LE. A direct anatomical study of additional renal arteries in a Colombian mestizo population. Folia Morphol (Warsz) 2008;67:129-34.  Back to cited text no. 10
    
11.Budhiraja V, Rastogi R, Asthana AK. Renal artery variations: Embryological basis and surgical correlation. Rom J Morphol Embryol 2010;51:533-6.  Back to cited text no. 11
    
12.Ankolekar V, Sengupta R. Renal artery variations: A cadaveric study with clinical relevance. Int J Curr Res Rev 2013;5:154-60.  Back to cited text no. 12
    
13.Nayak SB, Sirasanagandla SR, Shetty SD, Kumar N. Multiple vascular variations at the vicinity of the left kidney. Anat Sci Int 2013;88:230-3.  Back to cited text no. 13
    
14.Weld KJ, Bhayani SB, Belani J, Ames CD, Hruby G, Landman J. Extrarenal vascular anatomy of kidney: Assessment of variations and their relevance to partial nephrectomy. Urology 2005;66:985-9.  Back to cited text no. 14
    
15.Gupta V, Kotgirwar S, Trivedi S, Deopujari R, Singh V. Bilateral variations in renal vasculature. Int J Anat Var 2010;3:53-5.  Back to cited text no. 15
    
16.Nayak SR, J JP, D'Costa S, Prabhu LV, Krishnamurthy A, Pai MM, et al. Multiple anomalies involving testicular and suprarenal arteries: Embryological basis and clinical significance. Rom J Morphol Embryol 2007;48:155-9.  Back to cited text no. 16
    
17.Ciçekcibaºi AE, Salbacak A, Seker M, Ziylan T, Büyükmumcu M, Uysal II. The origin of gonadal arteries in human fetuses: Anatomical variations. Ann Anat 2002;184:275-9.  Back to cited text no. 17
    
18.Siniluoto TM, Hellström PA, Päivänsalo MJ, Leinonen AS. Testicular infarction following ethanol embolization of a renal neoplasm. Cardiovasc Intervent Radiol 1988;11:162-4.  Back to cited text no. 18
    


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