2004, Number 3
Multislice angiography of renal veins and arteries
Saavedra AJ, Kimura FK, Alcántara CJ, Stoopen ME, Ruíz SO, Cardona PM
Full text
Language: Spanish
References: 6
Page: 169-174
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ABSTRACT
Objective: At present Multislice Computed Angiotomography (MCAT) is the method of choice to study renal vascularity, it has replaced conventional angiography. Nowadays a great number of surgeons operate on the kidneys with only the information from the renal Multislice Angiotomography. To show the technique for renal MCAT in the study of kidney vascularity in patients who will be donors for a renal transplantation, in patients with arterial hypertension in whom there is suspicion of a reno-vascular origin and in patients that were subject to a renal transplantation. We will evaluate renovascular anatomy and its variants, the protocols for image acquisition, study technique with contrast media, as well as three dimension image postprocessing techniques.Materials and Methods: Fifty-three renal MCAT studies were performed from March, 2001 to November, 2003. A 4-slice per rotation Multislice Tomography was used. A protocol was implemented to clearly demonstrate renal arteries and veins, with Maximum Intensity Projection (MIP) and Volume Rendering (VR) reconstructions.
Results: In 24 patients renal vascularity was normal, and 26 had anatomic variants. In three patients, two had fibromuscular dysplasia of the renal artery and one had a Bosniak IV malignant cystic tumor. The anatomic variants were: seven (27%) with an accessory polar superior renal artery, eight (31%) with an accessory inferior polar artery, five (19%) with a pre-hilar accessory artery, 12 (46%) with an hilar accessory artery, six (23%) with an accessory renal vein, two (8%) with two accessory veins, and two (8%) with three accessory veins. As incidental findings seven patients had simple renal cysts, one with an hepatic cyst, one with a granuloma in the spleen, two with nephrolyths, one with a lymphocele, one with a double infrarenal inferior vena cava, two patients had calcified gallbladder stones, one with an aneurysm in the anastomosis of the transplanted kidney, and one patient with ureter-pelvic stenosis.
Conclusions: Renal Angiotomography is very useful to demonstrate the caliber and route of renal arteries and veins, as well as their multiple anatomic variants, so the surgeon can have an exact mapping of the renal vascular anatomy and can plan the surgery. Today renal MCAT replaces conventional Angiography, and is a safe and cheaper method for the study of kidney vascularity. The MCAT showed a normal anatomic pattern in 44% of the studied patients, 49% had variants; the most frequents variant were an accessory pre-hilar renal artery (46%), an accessory inferior polar artery (31%), an accessory superior polar artery (27%), and an accessory renal vein (23%).
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