August 21, 2014

Renal Artery Variants in Patients with Normal Renal Function

3D volume rendered CT image shows a 2nd right renal artery (arrows) arising from the right common iliac artery


  • "Normal" renal arterial arrangement = single bilateral renal arteries with hilar segmental branching. This occurred in 46% of cases in a landmark angiographic report published in 1978
  • Normally, no intrarenal arterial anastomoses are present. Each artery represents an end artery -- interruption results in infarction of that segment
  • Variations include double renal arteries, triple renal arteries, pre-hilar segmental branching, fetal lobulation and exaggerated size difference (greater than 2 cm). 
  • Most common variations are multiple renal arteries followed by pre-hilar segmental branching

Knowledge of Renal Vascular Variations is Important For:

  • Renal transplantation
  • Renovascular hypertension
  • Vascular reconstruction for congenital and acquired lesions
  • Reconstructive surgery for abdominal aortic aneurysms
Our case: Double right renal artery with the smaller branch originating from the common iliac artery

- Harrison, Jr., et al. Incidence of anatomical variants in renal vasculature in the presence of normal renal function. Ann Surg 1978;188:83-89.
- Ozkan U, et al. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 2006;12:183-6.

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