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      Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography

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          Summary

          Background:

          Great variability in the vasculature of the abdominal organs makes the pre-operative evaluation of arterial anatomical conditions extremely important and helpful. The aim of our study was to establish the prevalence of anatomical variations of the arteries branching from the abdominal aorta and to compare the results with the ones presented in the literature.

          Material/Methods:

          The material included computed tomography angiographies (CTA) of 201 patients (91 women and 110 men) performed between September 2007 and December 2008. The CTA examinations were conducted with a 64-detector CT scanner at the Department of Radiology of University Hospital in Wrocław. Images were obtained during the arterial phase and were analyzed for the presence of potential anomalies of the branches of the abdominal aorta.

          Results:

          In 88 patients (43.8%), there were anatomical variations of the arteries branching from the abdominal aorta. Variations of the renal arteries were observed in 83 (41.3%) patients, anomalies of the celiac trunk in 9 patients (4.5%), including variations of the superior mesenteric artery in 4 (2%) patients. No anatomical anomalies of the inferior mesenteric artery were shown in this study.

          The most frequent anomaly of the renal vasculature was the presence of at least one additional renal artery, observed in 65 (32.3%) patients. This concerned the inferior renal polar artery mainly – in 30 (14.9%) patients. Presence of bilateral additional renal arteries was visualized in 10% (20/201) of the cases. The most frequent anomalies of the celiac trunk were the celiacmesenteric trunk (in 3 patients – 1.5%) and the hepatosplenic trunk (in 3 patients – 1.5%). The celiac-mesenteric trunk was also the most frequent variation of the superior mesenteric artery in our material.

          Conclusions:

          A large part of population – 43.8% of our patients – demonstrated variations of arteries branching from the abdominal aorta. The anomalies were significantly more often found within the renal arteries than within the celiac trunk or the superior mesenteric artery. Sixty-four detector CTA reveals a high sensitivity in the detection of anomalies of the arteries branching from the abdominal aorta.

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          Most cited references27

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          Renal artery origins and variations: angiographic evaluation of 855 consecutive patients.

          To determine angiographically the origins and variations of renal arteries. The study included 855 consecutive patients (163 females, 692 males; mean age, 61 years) living in the Cukurova region of Turkey, who underwent either aortofemoropopliteal (AFP) angiography for the investigation of peripheral arterial disease, or renal angiography for renovascular hypertension, and were prospectively evaluated. Renal arteries were visualized by non-selective catheterization during AFP angiography and by selective or non-selective catheterization during renal angiography. Locations of renal artery origins and renal artery variations, including the presence of extra renal arteries and division patterns were analyzed on angiograms. The origin of main renal arteries off the aorta was between the upper margin of L1 and lower margin of L2 vertebra in 98% of the patients, and in 74%, this was the origin of extra renal arteries. The most common location for renal artery origin was the L1-L2 intervertebral disc level. A single renal artery was present in both kidneys in 76% of patients. Renal artery variations included multiple arteries in 24%, bilateral multiple arteries in 5%, and early division in 8% of the cases. Additional renal arteries on the right side were found in 16% and on the left side in 13% of cases. Of all the extra renal arteries, the percentage of accessory and aberrant renal arteries were 49% and 51%, respectively. Renal arteries originated between the first and the second lumbar vertebral levels in most patients. Extra renal arteries were quite frequent. These results should be kept in mind when a non-invasive diagnostic search is performed for renal artery stenosis, or when renal surgery related to renal arteries is performed.
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            Additional renal arteries: incidence and morphometry.

            Advances in surgical and uro-radiological techniques dictate a reappraisal and definition of renal arterial variations. This retrospective study aimed at establishing the incidence of additional renal arteries. Two subsets were analysed viz.: a) Clinical series--130 renal angiograms performed on renal transplant donors, 32 cadaver kidneys used in renal transplantation b) Cadaveric series--74 en-bloc morphologically normal kidney pairs. The sex and race distribution was: males 140, females 96; African 84, Indian 91, White 43 and "Coloured" 18, respectively. Incidence of first and second additional arteries were respectively, 23.2% (R: 18.6%; L: 27.6%) and 4.5% (R: 4.7%; L: 4.4%). Additional arteries occurred more frequently on the left (L: 32.0%; R: 23.3%). The incidence bilaterally was 10.2% (first additional arteries, only). The sex and race incidence (first and second additional) was: males, 28.0%, 5.1%; females, 16.4%, 3.8% and African 31.1%, 5.4%; Indian 13.5%, 4.5%; White 30.9%, 4.4% and "Coloured" 18.5%, 0%; respectively. Significant differences in the incidence of first additional arteries were noted between sex and race. The morphometry of additional renal arteries were lengths (cm) of first and second additional renal arteries: 4.5 and 3.8 (right), 4.9 and 3.7 (left); diameters: 0.4 and 0.3 (right), 0.3 and 0.3 (left). Detailed morphometry of sex and race were also recorded. No statistically significant differences were noted. Our results of the incidence of additional renal arteries of 27.7% compared favourably to that reported in the literature (weighted mean 28.1%). The study is unique in recording detailed morphometry of these vessels. Careful techniques in the identification of this anatomical variation is important since it impacts on renal transplantation surgery, vascular operations for renal artery stenosis, reno-vascular hypertension, Takayasu's disease, renal trauma and uro-radiological procedures.
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              Anatomic variation of the celiac trunk with special reference to hepatic artery patterns.

              Based on a large homogeneous sample from a Japanese population, anatomic variations in the celiac trunk (CT) and the hepatic artery were studied. Previously we analyzed the branching mode of the CT in 450 Japanese cadavers. In order to maximize the database on the CT and hepatic artery, we examined the anatomy of these arteries in 524 cadavers, a total of 974 cases. A total of 89.8% of cases showed the classical trifurcation of the CT. The typical normal pattern of the CT and the hepatic artery was confirmed in 66.6% and 72.4% of the cadavers, respectively. Variant left and right hepatic arteries were observed in 11.0% and 4.9%, respectively. A variant anatomy involving both the left and right hepatic arteries was found in 1.5%. A common hepatosplenic trunk and a gastrohepatic trunk were seen in 4.4% and 0.3%, respectively. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) or directly from the aorta was present in 3.5% or 0.5%, respectively. A hepatosplenomesenteric trunk and a celiomesenteric trunk were encountered in 0.7%, respectively. This anatomical update of the CT and the hepatic artery can be useful for transplantation and general surgeons, as well as vascular radiologists in this area.
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                Author and article information

                Journal
                Pol J Radiol
                Pol J Radiol
                Pol J Radiol
                Polish Journal of Radiology
                International Scientific Literature, Inc.
                1733-134X
                1899-0967
                Apr-Jun 2010
                : 75
                : 2
                : 38-45
                Affiliations
                [1 ] Student Scientific Group at the Department of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland
                [2 ] Depertment of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland
                Author notes
                Author’s address: Marek Sąsiadek, Depertment of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Borowska 213 Str., 50-556 Wroclaw, Poland, e-mail: mareks@ 123456rad.am.wroc.pl
                Article
                poljradiol-75-2-38
                3389861
                22802775
                9a083c6e-0468-4d03-9552-8700cd66d435
                © Pol J Radiol, 2010

                This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

                History
                : 25 March 2010
                : 06 April 2010
                Categories
                Original Article

                Radiology & Imaging
                anatomic variations,computed tomography angiography,abdominal aorta
                Radiology & Imaging
                anatomic variations, computed tomography angiography, abdominal aorta

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