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Variations in Testicular Artery, Phrenic Artery and Renal Artery: A Case Series |
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Geethanjali Basavaraj Savalgi, Roopashree Ramakrishna, V Jayanthi, H Mohan Kumar 1. Associate Professor, Department of Anatomy, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. 2. Professor, Department of Anatomy, East Point Medical College, Bangalore, Karnataka, India. 3. Principal and Dean, Professor, Department of Anatomy, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. 4. Professor and Head, Department of Ophthalmology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. |
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Correspondence Address : Geethanjali Basavaraj Savalgi, No. 45, 5th Cross, Malagal, Bangalore, Karnataka, India. E-mail: geethamohan76@gmail.com |
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| ABSTRACT |  | ||||||||||||||||||||||||||||||||||||||||||
: Anomalous blood vessels are important from the clinical aspects such as hydronephrosis, Varicocele leading to risk of infarction of kidney during renal transplant surgeries. Here, we report a case series of 30 cadavers of male and female aged between 40-80 years in the Department of Anatomy of a tertiary care institute in Bangalore, India. In three male cadavers, there was a variation in right testicular artery arising from abdominal aorta above the right renal artery later coursing downward, giving a branch to right kidney (10%). In another two male cadavers, right testicular artery (6.6%) was arising as branch of abdominal aorta above the right renal artery later coursing downward giving branch to right suprarenal gland and also observed right accessory renal artery branch of abdominal aorta arising below superior mesenteric artery and coursing upward to lower pole of right kidney. Observed in two male cadaver, inferior phrenic artery was arising as a common trunk from abdominal aorta above the main renal vessels and coursing laterally upward to diaphragm (6.6%). All the other branches of abdominal aorta and venous drainage were normal in the dissection of cadavers. The knowledge of these variations of arteries are essential before performing any transplantation surgeries, thus one can avoid the complications during uroradiological interventions. | |||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Hepatocellular carcinoma, Renal surgery, Renal transplantation, Varicocele of testis, Vascular variations | |||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2022/51265.2747
Date of Submission: Jul 06, 2021 Date of Peer Review: Sep 09, 2021 Date of Acceptance: Nov 02, 2021 Date of Publishing: Jan 01, 2022 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. No PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Jul 07, 2021 • Manual Googling: |
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| INTRODUCTION |
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The gonadal arteries are the paired branches of the abdominal aorta emerging normally a little inferior to the renal arteries above the inferior mesenteric artery. According to the gender, they are named as testicular or ovarian artery (1). The kidneys and gonads both develop from the intermediate mesoderm and supplied by the lateral mesonephric branches of the dorsal aorta. Caudal group of mesonephric branches give rise to gonadal artery while their persistence give rise to accessory renal artery. During the ascending of kidney and descending of gonads, they receive two main branches of mesonephric arteries, the one above and the other below. The lower branch usually atrophies when the organs reach their final position. Anomalies during the degeneration of these primitive arteries might lead to variations (2),(3),(4). Normal pattern of gonadal artery was followed in the 83-75% to least 4.7% (5),(6),(7). The gonadal arteries arise from the main renal arteries with a frequency which varies from 1.47-17% (5),(8) while their origin from an accessory renal artery ranges from 5.5-31.25% and it occur bilaterally only in the 1.1% of cases (2),(6). In addition to the normal pattern, several other sites of origin of the gonadal artery have been described; among them the renal, accessory renal and suprarenal arteries are most commonly mentioned and more rarely from the lumbar, common iliac or internal iliac and superior epigastric artery (9). Variation in origin of inferior phrenic arteries may arise from a common aortic origin with the coeliac trunk, from the coeliac trunk itself or from the renal artery (1). The accessory renal artery apart from main renal artery supplying kidney arises from the main renal artery or from the aorta or from a branch of the aorta which enters the kidney at either pole (10). | |||||||||||||||||||||||||||||||||||||||||||
| Case Report |
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An observational study was done to find any variations in branches of abdominal aorta during the routine dissection of posterior abdominal wall of 30 cadavers (20 males and 10 females) aged between 40-80 years were dissected for a period of two year in 2020 and 2021 in the Department of Anatomy, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India. The posterior abdominal wall was dissected to find the variations in the branches of abdominal aorta. Inclusion criteria: Cadavers with no previous history of abdominal surgery and age between 40-80 years were included in the study. Exclusion criteria: Cadavers with previous history of abdominal surgery and with adhesions of posterior abdominal wall were excluded from the study. Incidence of phrenic artery, testicular artery, accessory artery was 3.3%, 6.6% and 6.6%, respectively (Table/Fig 1). Posterior abdominal wall was dissected to find the variations in the branches of abdominal aorta after reflecting the peritoneum of posterior abdominal wall. A clean dissection of abdominal aorta and its branches were done. We observed in three male cadavers, there was a variation in right testicular artery (10%) arising from abdominal aorta above the right renal artery coursing downward giving a branch to right kidney crossing anterior to right renal vessels, right ureter and later taking normal course (Table/Fig 2). In another two male cadavers, the authors observed that the right testicular artery (6.6%) was arising as branch of abdominal aorta above the right renal artery at the level of superior mesenteric artery giving a branch to right suprarenal gland, going downward crossing anterior to right renal vessels, right ureter and later taking normal course and also observed right accessory renal artery arising from abdominal aorta below the renal vessels, crossing anterior to inferior vena cava going to lower pole of right kidney (Table/Fig 3). Observed in two male cadavers in which inferior phrenic artery (6.6%) was arising as a common trunk from the abdominal aorta just above and lateral to coeliac trunk and above the main renal vessels (Table/Fig 4), later dividing into right and left branches to supply diaphragm. All the other branches of abdominal aorta and venous drainage were normal in the cadavers taken for the study. | |||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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Normal pattern of gonadal artery was followed in 83-75% to least 4.7% (4),(5),(6). Variation in high origin of testicular artery from abdominal aorta was as follows: • Originating 1 cm superior to the origin of the inferior phrenic artery branched off and subdivided into a supernumerary inferior phrenic artery and a superior suprarenal artery (9) • Originating at the level of the right renal artery (10) • Arising from the abdominal aorta at the level of the left renal artery (11) • High origin of the left testicular artery originating from the left renal artery (12) • Originating from the left renal artery branch of the inferior polar artery emerging from the main renal artery on one right side or as double testicular artery. Study showed that there was no gender related difference in the course and origin of the gonadal arteries (13). The variations in the origin of the gonadal artery observed in spontaneously aborted foetuses was classified into four types Type1 as origin from the suprarenal artery, Type 2 as origin from the renal artery, Type 3 as high-positional origin from the abdominal aorta, at the level of the renal artery and Type 4 as duplication of the testicular artery (8). Notkovich H et al., described the relationship of the testicular artery to the renal vein, the anatomical variations are divided into three types (14): Type 1 as testicular artery arising from the aorta, passing posterior or inferior to the renal vein but without making contact with it, Type 2 as testicular artery from the aorta, superior to the renal vein and crossing in front of it and Type 3 as testicular artery arising from the aorta and passing posterior or inferior to the renal vein and coursing superiorly and around the renal vein. The gonadal artery variation can also be associated with other variations in origin of coeliac trunk. Inferior phrenic artery and the accessory arteries usually arise from the aorta, above or below the main renal artery and follow it to the renal hilum (15). The incidence of the accessory renal arteries has a wide range between 8.7% and 75.7% (16). The inferior phrenic artery usually originates from the aorta or coeliac trunk and less frequently from the renal, hepatic or left gastric arteries. Variations in origin of the inferior phrenic artery were as common trunk in 33.3%, on the left side in 33.3% as the source of the inferior phrenic artery (3). Rare case of inferior phrenic arteries trunk reported as originating from a common stem with a superior additional left renal artery from the abdominal aorta as revealed by routine multidetector computed tomography angiography (17). The present case series coincide with origin of testicular artery with Cicekcibasi AE et al., studies classification type 3 as high-positional origin from the abdominal aorta, in the level of the renal artery and with Notkovich H studies classification of type 2 (2),(14). (Table/Fig 5) showing incidence of origin of testicular artery variations with other authors (2),(7),(8),(11),(12),(13),(14),(15),(16). Embryological basis: The kidneys and gonads both develops from the intermediate mesoderm and supplied from lateral mesonephric branches of the dorsal aorta. Caudal group of mesonephric branches give rise to gonadal artery while their persistence give rise to accessory renal artery. During the ascending of kidney and descending of gonads they receive two main branches of mesonephric arteries the one above and the other below. The lower branch usually atrophies when the organs reach their final position. Anomalies during the degeneration of these primitive arteries might lead to variations (8),(18),(19),(20). These anomalies may be important from the clinical point of view in that they may cause Varicocele, hydronephrosis, Nephroptosis and malrotation of the kidney. | |||||||||||||||||||||||||||||||||||||||||||
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