Multiple Variations of Abdominal Arterial Anatomy: Morphological Description and Clinical Relevance

Objective: To report the altered renal hilar anatomy and composite variations in vasculature of kidney, suprarenal gland and testis with possible causes on embryological aspect. Materials and methods: Multiple arterial variants relating to urogenital organs were encountered in an eighty-two years old Indian male cadaver during dissection of posterior abdominal wall for gross anatomy teaching program. Results: On the left side, twin renal arteries (main and accessory) offshooted from the abdominal aorta. The left testicular artery was a direct branch of main renal artery. Significantly, the whole hilar anatomy was oriented in three planes showing divisions of twin renal arteries, tributaries of renal vein and extra pelvi-calcyceal system in a deeply excavated renal hilus. The only arterial supply to left suprarenal gland was from two tiny arteries (middle suprarenal) arising from abdominal aorta. The right inferior suprarenal artery was remarkably short. A number of branches took origin from it namely the right testicular artery, aberrant renal artery, twin arteries for suprarenal gland and right inferior phrenic artery. The superior and middle suprarenal arteries were absent on this side. The renal artery on the right side gave an aberrant artery. Conclusion: The anomalous arterial pattern of antero-lateral visceral arteries of posterior abdominal wall is of vital importance for surgeons during intra abdominal surgeries and laparoscopic procedures. Awareness of such anomalies is useful to urologists while performing angiography, nephron preserving surgery, kidney transplantation and management of renal vascular hypertension. The radiological and angiographic studies also require a thorough familiarity with these variations for correct interpretations.