Giriş ve Amaç: Bu araştırmanın amacı geniş bir hasta popülasyonunda
MDCT Anjiografi ile; renal arter orjinleri, renal arter ve ven varyasyonlarının ayrı
ayrı ve birlikte görülme sıklığı, multipl renal arter ve ven varyasyonunun
kategorizasyonu, cinsiyetle ilişkileri gibi detaylı araştırma yapılıp literatüre katkı
sağlamaktır.
Bulgular: Renal arter orjinleri; her iki ana renal arter orjinleri en sık L1
vertebra korpusu üst kenarı seviyesinde olmak üzere, her iki ana renal arter büyük
oranda L1 vertebra korpusu üst kenarı ile L2 vertebra korpusu alt kenarı arasında
orjin almaktadır (sağ ana reanl arterde % 88.9, sol ana renal arterde ise % 92.4).
Renal arter varyasyonlarının oranları; renal arterde tek taraflı erken dallanma % 13.8
(sağda % 9.1, solda % 5.5), çift taraflı erken dallanma % 0.5, tek taraflı multipl renal
arter % 21.4 (sağda % 19.4, solda % 20.6 ), çift taraflı multipl renal arter % 7 olarak
saptandı. Multipl renal arterler sayılarına göre kategorize edildiğinde double renal
arter sıklığı sağda % 19.2, solda % 19.3 ; triple renal arter sıklığı sağda % 1.8, solda
% 2; quadruple renal arter sıklığı solda % 0.3'dir. Çift taraflı double renal arter
sıklığı % 4.2 ve en sık bilateral double hiler arter varyasyonu saptanmıştır. Multipl
renal arterler hiler, superior polar ve inferior polar olarak sınıflandırıldığında ise hiler
aksesuar arter sıklığı sağda % 16.8, solda % 16.8; süperior polar arter sıklığı sağda
% 3.7, solda % 4.7; inferior polar arter sıklığı sağda % 1.5, solda % 0.9 'dur. Renal
ven varyasyonlarının oranları; tek taraflı multipl renal ven % 29.3 (sağda % 28.9,
solda % 1.2 ), çift taraflı multipl renal ven % 0.2; tek taraflı geç venöz konfluens %
20.4 (sağda % 9.2, solda % 12.7), çift taraflı geç konfluens % 1.3; sirkumaortik sol
renal ven % 3.4, retroaortik sol renal ven % 5.8 olarak bulduk. Multiple renal venler
sınıflandırıldığında double renal ven sıklığı sağda % 26.8, solda %1.1; triple renal
ven sıklığı sağda % 2.0, solda 0.1 ; quadruple renal ven sıklığı sağda % 0.1 ve
bilateral double renal ven sıklığını % 0.5 olarak tespit ettik. Renal arter ve ven
varyasyonunun birlikteliği % 22.9 ve en sık sol hiler arter ve sağda double renal ven
birlikteliğini saptadık.
Sonuç: Ana renal arterde erken dallanma, ana renal venlerde geç konflüens
gibi varyasyonların, renal arter ve ven varyasyonlarının birlikte görülme sıklığınının
literatürde belirtilen oranlardan daha fazla oranda olabileceğini tespit ettik. Bu
durumun girişimsel ve cerrahi işlemlerde göz önünde bulundurulması önem taşımaktadır.
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Introduction and Objective: The purpose of this study is to contribute to the
literature with detailed research such as the prevalence of renal artery origin levels,
renal artery (RA) and renal vein (RV) variations separately and together,
categorization of multiple renal artery and vein variations, the distribution of these
variations with respect to gender on multi-detector computed tomographic (MDCT)
angiography in a wide patient population.
Results: Renal artery origins; both main renal arteries most commonly at the
upper edge of the L1 vertebrae corpus and both main renal arteries originating
mainly between the upper edge of the L1 vertebrae and the lower edge of the L2
vertebrae (right main renal artery 88.9% and left main renal artery 92.4%). Ratios of
renal artery variations; the frequency of uni- or bilateral early branching of main
renal artery were found to be 13.8% (right 9.1%, left 5.5%) and 0.5% whereas uni- or
bilateral multiple renal arteries were found to be 21.4% (right % 19.4, left % 20.6)
and 7% respectively. When the multiple renal arteries were categorized according to
their numbers, the frequency of double renal artery was 19.2% on the right and
19.3% on the left; the frequency of triple renal artery was 1.8% on the right and 2%
on the left; The frequency of quadruple renal artery was 0.3% on the left. Bilateral
double renal artery incidence was 4.2% and bilateral double hilar artery variation was
the most common. When multiple renal arteries were classified as hilar, superior
polar and inferior polar, the frequency of hilar accessory artery was 16.8% on the
right and 16.8% on the left; superior polar artery frequency was 3.7% on the right
and 4.7% on the left; inferior polar artery frequency was 1.5% on the right and 0.9%
on the left. Ratios of renal vein variations; unilateral multiple renal vein 29.3% (right
28.9%, left 1.2%), bilateral renal vein 0.2%; unilateral late venous confluence 20.4%
(right 9.2%, left 12.7%), bilateral late venous confluence 1.3%; circumaortic left
renal vein was 3.4%, retroaortic left renal vein was found to be 5.8%. When multiple
renal veins were classified, the frequency of double renal vein was 26.8% on the
right and 1.1% on the left; the frequency of the triple renal vein was 2.0% on the
right and 0.1 on the left; the frequency of quadruple renal vein was 0.1% in the right
and the frequency of bilateral double renal vein was 0.5%.
The frequency of coexistence of renal artery and vein variations were found
to be 22.9% and the most frequent coexistent variation were found to be presence of
left hilar artery and double renal vein on the right side.
Conclusion: We found that the prevalance of early branching of the main
renal artery, variations of late venous confluens in the main renal veins, coexistent of
renal artery and vein variations may be higher than the rates reported in the
literature.It is important to consider this situation in interventional and surgical procedures. |