Vascular variations of the kidney, retrospective analysis of computed tomography images of ninety-one laparoscopic donor nephrectomies, and comparison of computed tomography images with perioperative findings

Abstract

Background: In this retrospective study, we aimed to determine the variations of kidney arteries and veins in kidney donor patients who underwent preoperative, computed tomography angiography. Materials and methods:We analyzed kidney computed tomography angiography findings of ninety-one donor nephrectomy patients operated from July 2016 through December 2017.Demographics, vascular diameters, abnormalities, numbers, branching variations, routing variations of arteries, and veins were assessed according to computed tomography angiography images. We also compared the radiological findings with perioperative findings.Two radiologists evaluated computed tomography angiography images, and the same surgical team performed all donor nephrectomies by laparoscopic approach.Results: Ninety-one of the 96 patients involved to study. Forty-six (50.5%) patients were female. Thirty-five (38.4%) of 91 cases had accessory arteries. Seven right (7.6%), one left (1.1%) and eight (8.7%) bilateral double hilar artery was observed on computed tomography angiography. No statistically significant difference was observed in the evaluation of the side of accessory/ polar arteries (p>0.05), and in the evaluation of the distribution of arterial/ venous variations according to perioperative findings (p>0.05). However, in the evaluation of computed tomography angiography images, we found that the diameter of the kidney artery and vein differed according to gender and side. Conclusions:The knowledge of the vascular variations of the kidney is essential for surgeons performing kidney transplantation. It is also essential for urologist and vascular surgeons.Incompatible with the literature, the right kidney has more vascular variations and, one kidney artery is found in the majority of Turkish kidney donor patients.

Methylene blue usage for determining accessory artery ligation in donor kidneys

“…Donor kidneys with multiple arteries are commonly observed (25%–30%) in renal transplantation surgeries. 9-11 When transplanting these kidneys, it is challenging for surgeons to make a decision regarding arterial ligation because the blood supply range of a certain artery cannot be evaluated by the naked eye. Therefore, we present a new technique to evaluate arterial blood supply before ligation.…”

Image-guided study of swine anatomy as a tool for urologic surgery research and training

“…According to the literature, in humans, the diameter of renal veins may vary between 5 and 17 mm 37 . A tomography study points out an average diameter of 6.98 mm at the right side and 6.36 mm at the left side in men and 6.69 mm at the right and 6.04 mm at the left side in women 34 . In Great Polish White pigs, between 70 and 110 kg, the average previously described is 10.94 mm, with variations between 4.5-15.8 mm 37 .…”

“…The most frequent pattern, as in this study, is the Ia, detected in 77-97% 4,16 . In both pigs and humans, renal arteries often originate from the abdominal aorta between the first and second lumbar vertebrae (L1-L2) 29,33,34 . In pigs, the numbering of the vertebrae may vary, as different breeds may differ in the number of vertebrae 35 .…”

“…The renal artery diameter in adult humans varies between 4.0 and 5.9 mm and between 5.1 and 5.4 mm in pigs 4,25,34,36 . In pigs, this data was collected using surgical dissection, plastination and angiography in animals of different breeds between 51 and90 kg 4,25 .…”

Renal Computed Tomography Angiography Protocol and Radiation Dose in Kidney Transplant Donors

“…Canlı böbrek nakli için organ bağışı oranları değişken olmasına rağmen, son zamanlarda batı dünyasında da baskın böbrek nakli seçeneği haline gelmiştir (7,8). Nakil öncesinde vericinin böbrek anatomisinin değerlendirilmesi cerrahlar açısından oldukça önemli olup, non-invaziv renal bilgisayarlı tomografi anjiyografi (RBTA) vasküler varyasyonların saptanmasında yararlıdır (9). Canlıdan böbrek naklinde, cerrahi planlamaya etkisi olan arter, ven ve üreterlerin anatomisi ile varyasyonların saptanmasında BT'nin genel doğruluğu sırasıyla %94, %97 ve %99'dur (10).…”