CT Angiography for Living Kidney Donors: Accuracy, Cause of Misinterpretation and Prevalence of Variation

Abstract

Objective: To determine the accuracy of the use of multi-detector row CT (MDCT) to predict vascular anatomy in living kidney donors and to reveal the prevalence of vascular variations in a Korean population. Materials and Methods:A total of 153 living kidney donors that had undergone preoperative CT and nephrectomy, either with open or laparoscopic surgery, were selected retrospectively. The initial CT results were compared with the surgical findings and repeated review sessions of CT scans were performed to determine the causes of mismatches in discordant cases. Results:The accuracy of CT angiography was 95% to predict the number of renal vessels. Four arteries and two veins were missed during the initial CT interpretation due to perception errors (for two arteries and two veins) and technical limitations (two arteries). The prevalence of multiple renal arteries and veins, early branching of a renal artery and late confluence of a renal vein were 31%, 5%, 12%, 17%, respectively. The circumaortic renal vein and the bilateral inferior vena cava were found in two cases each (1.3%). One case (0.7%) each of a retroaortic renal vein and a supradiaphragmatic originated renal artery were found. Conclusion: MDCT provides a reliable method to evaluate the vascular anatomy and variations of living kidney donors.enal transplantation is associated with better survival and quality of life in end-stage renal disease patients than performing dialysis, and living donor renal transplantation has been shown to offer better graft survival than cadaver donor renal transplantation. However, adequate preoperative living kidney donor evaluation is mandatory to reduce the possible occurrence of surgical complications that can threaten the graft, and sometimes the survival of the recipient (1).The usefulness of single section helical computed tomography (CT) for the preoperative evaluation of living kidney donors has been well established (2 4). Several investigators have also described the use of multi-detector row CT (MDCT) for the preoperative evaluation of living kidney donors (5, 6).The study presented here is the largest to date in terms of the number of cases among studies that have examined the accuracy of MDCT that is reconstructed at a 1.00 1.25 mm slice thickness to predict renal vascular anatomy in living renal donors. We also evaluated the cause of misinterpretations by CT. In addition, the prevalence of renal vessel variations in a Korean population was determined.

Persistent Increase in Blood Pressure After Renal Nerve Stimulation in Accessory Renal Arteries After Sympathetic Renal Denervation

“…Indeed, the prevalence of renal accessory and multiple arteries varies between 15% and 30% in most populations. 11,12,18 In a recent series of 941 hypertensive patients who underwent coronary angiography, 21% of patients had either aberrant or accessory renal arteries, and the mean diameter of nonprincipal renal arteries was 2.9 mm, 19 which means that in a substantial proportion, RDN would not have been feasible. The proportion of patients with multiple renal arteries reached 34% in a Dutch monocentric cohort of 126 hypertensive patients referred for RDN.…”

Investigations on renal vascularisation pathology in the Polish population. 1. Incidence of multiple kidney arteries

“…In selected cases of postmortem kidney donors the polar arteries were not recognised, and severed or damaged by the transplantologist [31]. The angiographic findings before surgery were in only 95-97% of cases in accordance with the intraoperative situation [6,28]. Multiple kidney arteries are one of the most difficult conditions considering laparoscopic renal donors [20].…”

Supernumerary renal vessels: analysis of frequency and configuration in 996 computed tomography studies

“…Multidetector CT has a high accuracy of detection of anomalous renal vasculature, ranging from 95% [2,14]. Noninvasive diagnosis of variant renal vasculature has become of high importance with the development of minimally invasive renal nephrectomy [4,8,9].…”