Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

Duplicate testicular veins accompanied by anomalies of the testicular arteries.

Duplicate testicular veins associated with other anomalies of the testicular arteries were observed during dissection of the posterior abdominal wall in a 90-year-old Japanese male cadaver. The right testicular vein was composed of the medial and lateral testicular veins. The medial testicular vein drained into the inferior vena cava, whereas the lateral testicular vein drained into the confluence of the inferior vena cava and right renal vein. Several anastomosing branches were seen between the medial and lateral testicular veins. The left testicular vein was formed after the medial and lateral venous trunks joined and drained into the ipsilateral renal vein. The right testicular artery originated from the anterior surface of the abdominal aorta at the level of the left renal artery, passed posterior to the inferior vena cava, and accompanied the right lateral testicular vein running downwards. The left testicular artery arose from the abdominal aorta at a level of 5 cm below the origin of the right testicular artery, and then ran downwards accompanied by the medial trunk of the left testicular vein.     

Altered course of the right testicular artery

An unusual course of the right testicular artery was observed during routine dissection of the posterior abdominal wall of a 60-year-old male cadaver. It arose from the abdominal aorta, inferior and posterior to the origin of the right renal artery, and passed posterior to the inferior vena cava and right renal vein; it then arched anterior to the inferior pole of the right kidney and descended anterior to the psoas major muscle, crossing anterior to the genitofemoral nerve, ureter and the proximal part of the external iliac artery. Finally, it passed to the deep inguinal ring and through the inguinal canal to enter the spermatic cord with the other constituents. The left testicular artery arose from the abdominal aorta about 1 cm higher than the right testicular artery and followed a normal course. The embryologic basis and clinical importance of this case are discussed.     

Multiple variations of the renal and testicular vessels: possible embryological basis and clinical importance

During routine dissection of the abdominal cavity of a 55-year-old African male cadaver, multiple anomalies including renal and testicular vessels were encountered. The right kidney was supplied by three right hilar renal arteries arising from the abdominal aorta at different vertebral levels whereas only one left renal artery supplied the left kidney. On the right three renal veins drained the kidney into the inferior vena cava. In contrast, the left kidney was drained by a single renal vein which received a large primary posterior tributary. The primary posterior tributary had three tributaries from the posterior lumbar region. The right testis had two sources of arterial supply; one from the subcostal artery and another from the abdominal aorta. The left testis was supplied normally by a single testicular artery. The right testis was drained by four testicular veins as follows: one drained into the subcostal vein, the other two drained separately for a longer course and joined shortly before draining into the right main renal vein, the fourth one drained into the anterior aspect of the inferior vena cava at the level of the second lumbar vertebra. On the left, the testicle was drained by two testicular veins which travelled separately from the deep inguinal ring and joined shortly before they drain into the left renal vein. This variation may represent an immature form of complicated development of kidneys and testes. Additionally, emphasis must be put on preoperative vascular examination to avoid surgical complications from variant vessels in this region.     

Multiple renal vessels associated with testicular vessels

A rare case of multiple renal vessels associated with testicular vessels was found from 85-year-old male cadaver undergoing routine dissection. The characteristic findings in the cadaver included the presence of five right renal arteries and three left renal arteries arising from the abdominal aorta, and the right testicular artery originated from the right middle hilar artery and the left testicular artery originated from the left inferior hilar artery. This variation may represent an immature form of complicated development of the kidneys and testes.     

Rare case of right accessory renal artery originating as a common trunk with the inferior mesenteric artery: a case report

Dissection of a male cadaver revealed several vascular abnormalities in the abdominal cavity, notably of the renal circulation. In particular, three renal arteries were observed on the right side and two on the left. On the right side, one accessory renal artery originated as a common trunk with the inferior mesenteric artery. Additional variations included a left inferior phrenic artery originating from the celiac trunk, bilateral testicular veins emptying into renal veins, and the left testicular artery arising from the left renal artery. The possible embryonic development of these branching patterns and their clinical significance are discussed briefly.     

Bilateral high origins of testicular arteries: a rare variant

We report a very rare case of bilateral high origins of testicular arteries in a 66-year-old Chinese male cadaver. The arteries originated from the antero-lateral aspect of the abdominal aorta, cranially to the origins of ipsilateral renal arteries. Approximately 1.1 cm after its origin, the right testicular artery gave off the middle suprarenal artery. During its course, the artery crossed anterior to the right renal vessels. The left testicular artery coursed posterior to the left suprarenal vein, anterior to the left renal vessels. Variants of the origin and course of the testicular artery are important during renal and testicular surgeries.     

An extremely rare bifurcation pattern of the caudal abdominal aorta: case report demonstrated by angiography

An extremely rare bifurcation pattern at the caudal abdominal aorta was encountered on the pelvic angiography and MR angiography of a male patient. Instead of dividing into two common iliac arteries, the caudal abdominal aorta first gave the right external iliac artery at the level of the last lumbar arteries, then bifurcated into a right internal iliac artery and a left common iliac artery. The median sacral artery originated at this anomalous bifurcation. This high origin of the right external iliac artery and separate branching of these right iliac vessels from the abdominal aorta are important during the interventions in the region. We present the angiography findings and discuss the embryological origin of this unusual and unreported congenital anomaly.     

High origin and unusual suprarenal branch of a testicular artery

In a 42 year-old male cadaver, the left testicular artery was found to originate from the anterior surface of the abdominal aorta at the level of origin of the left renal artery. It ran parallel and just inferior to the left renal artery and gave off a branch which supplied the left suprarenal gland. The course, relations and branching of this suprarenal branch differed from the very rare cases found in the literature. Awareness of the possible existence of such variations of the testicular arteries is of great importance during surgical procedures.     

High bifurcation of abdominal aorta upon horseshoe kidney at the level of upper L2 vertebral body: a rare case report

A high-positioned bifurcation of abdominal aorta upon a horseshoe kidney at the level of upper L2 vertebral body was detected during contrast enhanced abdominal computed tomography scan. The isthmus was clamped between the two elevated and extended common iliac arteries. The right renal artery arose from right common iliac artery supplying the superior and medium segments of right kidney. The left renal artery originated from right common iliac artery and branched off into three main arteries supplying the medium segment of right kidney, the inferior segment of right kidney and the lower half part of left kidney, respectively. The left accessory renal artery arose from abdominal aorta supplying the upper half part of left kidney. The inferior mesenteric artery arose from right common iliac artery. Lumbarization anomaly, scoliolosis, asymmetric pelvis and serious hydronephrosis of left kidney were also found. We describe this rare case of variations and discuss the possible embryonic development mechanism.     

Human doubled renal and testicular arteries.

Doubled renal and testicular arteries were found in a well-developed 69-year-old caucasian male. The right kidney had two renal arteries, one at its usual midorgan (hilar) position and one inferior polar. One testicular artery arose from the mid-point of the usual renal artery, passed under the renal vein at its junction with the inferior vena cava, and then crossed over the inferior polar renal artery. The second testicular artery arose from the inferior polar renal artery near its origin from the abdominal aorta. The two testicular arteries remained doubled throughout their course and both entered the right testis at separate sites on the organ. The inferior vena cava passed under the inferior polar and over the superior testicular artery and the superior renal artery.     

Rare origin of supernumerary renal vessels supplying the lower pole of the left kidney

The current observations have documented rare vascular anomalies in the right and left kidneys from a male and female cadaver, respectively. In the female left kidney in addition to being supplied by the normal renal artery and vein it contained a left lower polar renal artery and vein. The polar artery took origin from the inferior mesenteric artery to supply the lower pole and was drained by the left lower polar vein that opened into the left common iliac vein. The right kidney from a male cadaver showed supernumerary renal arteries and veins. The supernumerary upper renal artery took origin from the aorta and after a short course it gave rise into a cranial branch that took a long course to supply the lower pole and a caudal branch that entered the right kidney at the hilum. The supernumerary lower renal artery also took origin from the aorta and passed to supply the lower pole of the right kidney. Therefore, the lower pole of the right kidney received two arteries, but was not associated with a polar vein. The right kidney in addition to the normal right renal vein contained a supernumerary right renal vein. The vein was seen at the hilum and was the most posterior structure; passing behind the supernumerary lower renal artery to open into the posterior surface of the inferior vena cava. The anomalies described in the current observation present a unique pattern of congenital renal vascular abnormalities that may be of surgical importance.     

Left inferior vena cava with regressed right inferior vena cava

A left inferior vena cava was found in the cadaver of an 88-year-old Japanese man during a student dissection course at Kumamoto University School of Medicine. The right common iliac vein ascended obliquely toward the left behind the right common iliac artery and united with the left common iliac vein to form the inferior vena cava in front of the fifth lumbar vertebral body behind the left common iliac artery. The inferior vena cava ascended on the left side to the aorta, and after the left renal vein joined to it at the level of the third lumbar vertebral body, it turned obliquely to the right and crossed superficially to the aorta. At the right side of the aorta, the common stem of the third lumbar vein and the posterior renal vein was joined to the oblique part. The inferior vena cava then ascended, receiving the right renal vein as it would normally. The inferior vena cava is thought to develop symmetrically but this left inferior vena cava shows a persistence of the left channel of the infrarenal part, which normally disappears. Although the common stem of the veins that joined to the oblique part on the right side did not continue to the right common iliac vein, gross anatomical findings suggested it to be the remnant of the right inferior vena cava.     

Origins of the gonadal artery: embryologic implications

The gonadal arteries are paired vessels that usually originate from the abdominal aorta at the level of second lumbar vertebra. In 5-20% of cases, the gonadal artery has a high origin (superior to L2) and in 5-6% of cases it originates from the main or accessory renal artery. The latter is referred to here as an aberrant gonadal artery. Ninety-eight kidneys of 50 healthy potential renal transplant donors were prospectively studied by conventional angiography. The renal artery, either main or accessory, was detected and individually injected to highlight their perihilar divisions and possible extrarenal branches. The gonadal arteries were recorded if they originated from the renal arteries. We found that 39% (n = 38) of kidneys had at least one accessory renal artery. In 14 sides (14% of kidneys), the gonadal artery (11 right and 3 left) originated from the renal artery, either main (n = 5) or accessory (n = 9). Ten out of 14 kidneys with an aberrant gonadal artery had an associated accessory renal artery. In nine cases, the gonadal artery originated from the accessory renal artery, and in one case, although it originated from the main renal artery, the same kidney had an accessory arterial supply. The results of this study demonstrate that aberrant gonadal arteries tend to originate from kidneys that possess an accessory arterial supply. We hypothesize that aberrancies of the gonadal artery are a part of a common embryologic error resulting in the persistence of the future accessory renal arteries. We believe that this study is the first to hypothesize and study such an association with these arterial anomalies of the renal pedicle.     

Variations of the bilateral testicular veins: embryological and clinical considerations

Variations of the bilateral testicular veins were observed during routine dissection of the posterior abdominal wall in a 77-year-old male Japanese cadaver. The right testicular vein consisted of the lateral and medial testicular veins. The right lateral testicular vein drained into the right renal vein. The right medial testicular vein accompanied the right testicular artery to ascend obliquely and drained into the left aspect of the inferior vena cava. The left testicular vein was composed of the lateral, middle and medial testicular veins. Three left testicular veins accompanied the left testicular artery to course cranially and then finally drained into the left renal vein.     

Abnormal branch of the testicular artery

We present a case report of an abnormal course and branching of the right testicular artery, which was uncovered during routine dissection of the abdomen in our first year medical class. It arose from the anterior surface of the abdominal aorta and immediately divided into two branches; one branch coursed inferiorly behind the inferior vena cava as the testicular artery proper, while the other branch passed behind the inferior vena cava and emerged on the anterior surface of the right kidney. After crossing the anterior surface of the kidney, it bifurcated into an ascending branch that went to the right suprarenal gland and a descending branch that ended in the posterior abdominal wall. The left testicular artery was normal in its course and distribution. This is a very rare variation.     

Multiple vascular variations at the vicinity of the left kidney

Although isolated variations of the renal artery, renal vein and testicular artery are commonly described in the literature, the concurrent presence of variations in all three of these vessels has seldom been reported. Here, we report concurrent vascular variations in the vicinity of the left kidney. The left renal vein was found to have a retropelvic tributary, and a communicating vein connecting the inferior vena cava and retropelvic tributary was also noted. In addition, the left renal artery separated into anterior and posterior divisions just before reaching the hilum. The anterior division further divided into two segmental branches which had a peculiar ‘ram horn’ shape. The posterior division of the renal artery entered the substance of the kidney without forming any further branches. The left testicular artery arose from the aorta above the level of the renal artery and then passed in front of left renal vessels following a tortuous course. The anatomical knowledge of this unusual vascular pattern may be useful during renal vascular reconstruction, treatment of renal artery stenosis, endoscopic surgeries and clinical evaluation of renovascular hypertension.     

Multiple variations in the paired arteries of the abdominal aorta

Variations in the origin of arteries in the abdomen are very common. The arteries that show frequent variations include the celiac trunk, renal arteries, and gonadal arteries. We observed multiple variations in a 45-year-old male cadaver. The variations found on the left side were: one accessory renal artery, two testicular arteries, and middle suprarenal and inferior phrenic arteries that branched from the celiac trunk. On the right side, the inferior phrenic and middle suprarenal arteries arose from the right renal artery.     

An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance

We investigated the origin, localizations and anatomic variations of the renal artery (RA) in human fetuses with the aim of determining the distribution of these variations according to lateralization and gender. In total, 90 fetuses of spontaneous abortion (45 males, 45 females) with no congenital malformations were included to the study. The abdominal aorta and its branches were dissected after latex solution colored with red ink had been injected into the vessels from the thoracic aorta. In all, 180 RA dissections were performed bilaterally in 90 cases and the anatomic variations were photographed. Right and left RAs were found to originate from the following levels according to the columna vertebralis, respectively: 3.8% and 1.9% lower T12, 67.3% and 25.0% upper L1, 9.6% and 28.8% mid L1, 15.3% and 40.3 lower L1, 3.8% and 3.8% upper 1/3 part of L2 vertebra. The right RA originated from the lateral part and anterolateral wall of the abdominal aorta in 73.0% and 26.9% of cases while the lateral and anterolateral wall origin percentages of left RA were 90.3% and 9.6%, respectively. The origin site of the right RA from the abdominal aorta was superior to, at the same level with, and inferior to that of the left RA in 53.8%, 34.6% and 11.5% of the cases, respectively. There were no variations in 75% of the cases whereas the remaining 25% had several variation patterns. The presented morphological results are as follows: A single hilar artery in 75% of the cases, double hilar arteries in 11.1%, an inferior polar artery in 10.5%, and a superior polar artery in 3.3% of specimens studied. Anatomical variations were observed more frequently among male fetuses and on the right side. Knowledge of RA variations is important for surgeons in performing many procedures and may help to avoid clinical complications, especially, during radiological examination and/or surgical approaches in the abdominal region.