Int J Anat Res 2013, 03:136-39. ISSN 2321-4287

Case Report

ANOMALOUS LEFT TESTICULAR ARTERY ARISING FROM LEFTACCESSORY RENAL ARTERY AND ITS CLINICAL IMPLICATIONSRachna Magotra 1, Sajad Hamid 2, Nusrat Jabeen 3, Sunanda Raina 4, Sanjay Raina 5.

ABSTRACT

Address for Correspondence: Dr. Rachna Magotra, Assistant Professor , deptt of anatomy, GMC,Jammu, India. E-Mail: drsajadk@rediffmail.com

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1 Assistant Professor Anatomy, Govt. Medical College, Jammu, India.2 Lecturer SKIMS Medical college, Kashmir, India.3 Assistant Professor Anatomy Govt. Medical College, Jammu, India.4 Professor Anatomy, Govt. Medical College, Jammu, India5 Post-P.G. Demonstrator Anatomy, Govt. Medical College, Jammu, India.

Origin of the Testicular Artery variations were found during routine dissection of abdomen of the middle agedcadaver in the Dept of Anatomy, Govt. Medical College Jammu. On the left side there were two renal arteries,One of them was the main Renal artery which was originating from the anterolateral aspect of abdominal aortaand running to the hilum of the kidney in front of the renal vein The other was the Accessory Renal arterywhich was originating from anterolateral aspect of aorta 5mm above origin of main renal artery and going tothe upper pole of the kidney. The origin of accessory renal artery and main renal artery was 4.2 and 9.2mmbelow the level of origin of superior mesentric artery. The left testicular artery was originating from the acces-sory renal artery and crossing the renal artery and the renal vein anteriorly before following its usual course inthe posterior abdominal wall. Only one renal artery was seen on the right side arising from the anterolateralaspect of aorta. The right testicular artery originated 52mm below the origin of right renal artery and followedits normal course This anomaly is explained by embryological development of both kidneys and gonads fromintermediate mesoderm of mesonephric crest. Further the vasculature of kidneys and gonads is derived fromlateral mesonephric branches of dorsal aorta .Even though the condition presents as a silent renal anomaly(Undiagnosed throughout life and revealed only on autopsy) the surgical implications are noteworthy, whichtoo have been highlighted in this report.

KEYWORDS: Anomalous testicular artery; Accessory renal artery; Renal artery, Renal vein; Mesonephric crest.

INTRODUCTION

International Journal of Anatomy and Research,Int J Anat Res 2013, Vol 1(3):136-39. ISSN 2321- 4287

Received: 28 Sep 2013Peer Review: 28 Sep 2013 Published (O):30 Dec 2013Accepted: 01 Nov 2013 Published (P):30 Dec 2013

International Journal of Anatomy and ResearchISSN 2321-4287

www.ijmhr.org/ijar.htm

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Renal arteries and testicular arteries arise fromthe lateral or anterolateral aspect of abdominalaorta. Variations relating to origin, course &number of these arteries have been reported ina number of studies. The embryological basis ofthese variations has also been well established.From the published studies and reports aboutaccessory renal arteries it can be concluded thataverage rate of occurrence is approximately 30%Machnicki & Grzybiak examined the variation oftesticular artery in fetuses and adults . According

to their site of origin from the aorta or renalarteries four main types of testicular arterieshave been identified [1].Type 1- A single testicular artery arising from theaorta.Type 2- A single testicular artery arising from therenal artery.Type 3-Two testicular arteries arising from theaorta and penetrating the same gonad.Type 4- Two testicular arteries penetrating thetestes. One arising from the aorta and other fromthe renal artery.

Int J Anat Res 2013, 03:136-39. ISSN 2321-4287 137

CASE REPORT

Pai et al studied 34 adults male cadavers forvariation in origin, number and course of thetesticular artery. They found that testicularartery was normal in origin and course in 85.3%of cases. In 14.7% of cases variations in origin,number and course were found [2].In a study of Notkovich including 405 testicularor ovarian arteries the gonadal arteries of renalorigin were found in 14% taking their origin fromprincipal renal artery , from its branches or froman accessory renal artery [3].Shoja et al reported that gonadal arteryoriginated from main or accessory renal arteryand origin from inferior polar artery was themost common finding [4].Siniluoto et al observed inflammation of lefttestes secondary to Tran catheter embolizationof malignant left renal tumor with absoluteethanol [5]. This was probably due to testicularartery arising from the renal artery and itsbranches.Though mostly undiagnosed throughout the lifethe aberrant vasculature could provide aformidable challenge during surgery in thisregion. Preoperative aortography is oftenrequired to visualize the uncertain anatomy ofthe anomalous renal artery to minimize the riskof preoperative and postoperative hemorrhageassociated with the vascular surgery.The present case report not only aims atexplaining the possible embryological basis ofthis congenital anomaly but also the risk factorsassociated with surgical interventions in thisregion. The knowledge of the atypical anatomicalpresentation has gained importance with theadvent of newer surgical and operativetechniques.

One accessory renal artery superior to mainRenal artery was observed during routineabdominal dissection of a middle aged male ca-daver on the left side. The accessory renalartery originated from the anterolateral aspectof abdominal aorta 4.2mm below the origin ofsuperior mesenteric artery and ran into theupper pole of left kidney The main renal arteryoriginated from the anterolateral aspect ofabdominal aorta 9.2mm below the origin ofsuperior mesenteric artery and ran into the

middle pole (hilum) (fig-1) The renal artery wascrossing the left renal vein anteriorly (fig-2). Onthe right side there was a single renal artery aris-ing from the anterolateral aspect of abdominalaorta 11.3mm below the origin of superior me-senteric artery and going into the hilum of kid-ney The left testicular artery was arising fromthe accessory renal artery and then crossing therenal artery, renal vein, psoas, ureter, & exter-nal iliac artery (fig-3). The right testicular arterywas arising from the anterolateral part of aorta2.5cm caudal to the renal artery and then goingobliquely downwards and laterally behind peri-toneum into pelvic cavity. During its course it liesanterior to inferior vene cava, Psoas, Ureter andexternal iliac artery.Fig. 1: Showing origin of accessory and main left renalartery from the aorta.

Fig. 2: Showing left renal artery crossing the left renalvein anteriorly.

Fig. 3: Showing left testicular artery arising from anoma-lous left renal artery.

Rachna Magotra et al., Anomalous left testicular artery arising from left accessory renal artery and its clinical implications.

Int J Anat Res 2013, 03:136-39. ISSN 2321-4287 138

DISCUSSIONAnomalies of various vessels include variation intheir course and number. Certain knowledge ofembryology of renal vasculature anddevelopment of kidney is essential tounderstand the multitude of anomalies that mayoccur. With the complex development of kidneythrough three stages of pronephros,mesonephros and metanephros and themigration of kidney from pelvis to lumbarregion along with its longitudinal location andsimultaneous acquisition of a vascular supplythere is a reason to understand why thepossibility for anomalous development in kidneyis greater than that for other organs in body [6].Renal vasculature may be studied at variouslevels commencing with principal and accessoryrenal arteries. Their primary patterns ofbranching and areas of distribution suggest thepresence of vascular segmentation. From theprimary stems branch lobar, inter lobar, arcuate,inter lobular arteries, afferent and efferentglomerular arterioles and cortical intertubularcapillary plexuses, cortical venous radicles drainthem and also vasa recta and associated capillaryplexuses of medulla to the renal veins.The nomenclature of renal artery variation is stillunclear Nevertheless it is a misnomer to call suchvessels accessory, aberrant, or evensupernumerary because they are not extra butessential tissue sustaining arteries withoutanastomosis between them which correspondto the segmental branches of a single renalartery. So some authors name them as upperand lower hilar arteries regarding their relationwith the renal hilum Bordei et al found 54 doublerenal arteries originating from the aorta in 272kidneys (20%) and 6 of them were bilateral(2.2%) [7]. unfortunately no information aboutthe arteries being hilar or polar was given.Bergaman et al reported the frequency ofgonadal arteries originating from the renal arteryas 15%(8). Cicekcbasi et al classified the gonadalartery originating from the renal artery as typeii with the frequency of 5.5% [9]. In their studyall five cases in type ii had inferior polar origin Inthe present study the left testicular artery isoriginating from the renal artery going to theupper polar region Bordei et al found four casesof a single gonadal artery originating from

double renal arteries but did not gave anyinformation regarding laterality The anatomyof gonadal arteries has assumed importancebecause of development of new operativetechniques within abdominal cavity foroperations like varicocoele and undescendedtestis During laparoscopic surgery of maleabdomen and pelvis many complications occurdue to unfamiliar anatomy in operative field Thusit becomes imperative to carefully preserve thegonadal artery in order to prevent any vasculartroubles of gonad,the gonadal artery being itsunique source of blood supply This indicates theimportance of arteriography or Dopplerultrasound examination of renal hilum prior toany surgical procedure in this region.Embryological explanationFelix [10] stated that the developingmesonephros, metanephros, suprarenal glandsand gonads are supplied by nine pairs of lateralmesonephric arteries arising from dorsal aortaFelix divided these arteries into three groups asfollows:The first and second are cranial arteriesThe third to fourth are middle arteriesThe sixth to ninth are caudal arteriesThe middle group gives rise to renal arteries. Thepersistence of more than one arteries of themiddle group results as multiple renal arteriesThus the two renal arteries in this case are as aresult of two persisting mesonephric arteries ofthe middle group Felix also stated that althoughany of these nine arteries may become thegonadal artery it usually arises from the caudalgroup In the present case the testicular arteryhas originated from accessory renal artery so webelieve that it has been derived from middlegroup as well Brenmer explained that spermaticbranches of renal origin were due to an earlyconnection of a mesonephric artery with kidneywhich is normally lost [11]. Various growth/transcription factors and hemodynamic forcesmay take part in selection and persistence of aparticular congenital vascular channel Theparticular embryonic signals which lead toformation of accessory renal or aberrant gonadalartery are yet unknown.

Rachna Magotra et al., Anomalous left testicular artery arising from left accessory renal artery and its clinical implications.

Int J Anat Res 2013, 03:136-39. ISSN 2321-4287

Rachna Magotra et al., Anomalous left testicular artery arising from left accessory renal artery and its clinical implications.

How to cite this article:Rachna Magotra, Sajad Hamid, Nusrat Jabeen, Sunanda Raina,Sanjay Raina. ANOMALOUS LEFT TESTICULAR ARTERY ARISINGFROM LEFT ACCESSORY RENAL ARTERYAND ITS CLINICAL IMPLI-CATIONS. Int J Anat Res 2013;03:136-139.

CONCLUSION

Conflicts of Interests: None

REFERENCES

The present case report aims at highlighting ananatomic variation and its possible embryologi-cal variations. Even though the anomaly isrevealed only on autopsy and may remain undi-agnosed throughout life , the clinical implicationsare immense on proper diagnosis. Hence theanatomical knowledge of such anomaly wouldminimize the perioperative and postoperativemorbidity related to surgical interventions andcadaveric transplantations procedures.

ARA-Accessory renal arteryIVC-Inferior vena cavaRA-Renal arteryRV- Renal veinTA-Testicular arteryTV-Testicular vein

List of Abbreviations:

[3]. Notkovich.H.Variation of the testicular and ovarianarteries in relation to the renal pedicle.Surg GynecolObstet 1956;103:487-95.

[4]. Shoja MM, Tubbs RS,Shakeri AB,Oaks WJ.Origins ofthe gonadal artery;embryologic implications.ClinAnat 2007;20:428-32.

[5]. Siniluoto TM, Helstrom PA,Paivansalo MJ,LeinonenAS,Testicular infarction following Ethanolembolisation of a renal neoplasm.CardiovascIntervent Radiol 1988;11;162-64.

[6]. Olsson O Wholey M,Vascular abnormalities in grossanomalies of kidneys.Radiol Diagn1964;2;420-32.

[7]. Bordei P,Sapte E,Iliescu D,Dina C.The morphologyand the surgical importance of the gonadal arteriesoriginating from the renal artery Surg Radiol Anat2007;29:367-71.

[8]. Bergman RA, Affifi AK,Miyauchi R Gonadal (ovarianand spermatic or testicular)Arteries,In:AnatomyAtlases[online] Avai lable atwww.anatomyatlases.org/Anatomicvariants/C a r d i o v a s c u l a r / T e x t / A r t e r i e s /Gonadal.shtml.Accessed May1 2006.

[9]. Cicekcibasi AE, Salbacak A,Seker M etal, The originof gonadal arteries in human fetuses.Anatomicvariations Ann Anat 2002;184:275-79.

[10].Felix W Mesonephric arteries (aa mesophricae)InKiebel F,Mall FP eds,Manual of human embryologyVol 2,Philadelphia,Lippincott 1912;820-25.

[11].Brenmer J L, The origin of renal artery in mammalsand its anomalies.Am J anat 1915;18:179-200.

[1]. Machnicki A Grzybiak M.Variations in testiculararteries in fetuses and adults.FoliaMorphol(Warsz)1997;56:277-85.

[2]. Pai M.M.Vadgaonkar R, Rai R,Nayak S.R,JijiP.J,Ranade A,Prabhu LV,Madhyastha S.A cadavericstudy of the testicular A in the South Indianpopulation Singapore Med Journal 2008;49:551-55.

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