Bilateral variant testicular arteries with double renal arteries
© Sylvia et al; licensee BioMed Central Ltd. 2009
Received: 16 December 2008
Accepted: 02 February 2009
Published: 02 February 2009
The testicular arteries normally arise from the abdominal aorta. There are reports about the variant origin of these arteries. Accessory renal arteries are also a common finding but their providing origin to testicular arteries is an important observation. The variations described here are unique and provide significant information to surgeons dissecting the abdominal cavity.
During routine dissection classes of abdominal region of a 60-year-old male cadaver, we observed bilateral variant testicular arteries and double renal arteries.
Awareness of variations of the testicular arteries such as those presented here becomes important during surgical procedures like varicocele and undescended testes.
The testicular arteries are paired vessels that usually arise from the abdominal aorta at the second lumbar vertebral level. Each artery passes obliquely downwards and posterior to the peritoneum. Descending on the posterior abdominal wall, it reaches the deep inguinal ring where it enters the spermatic cord [1, 2]. There are reports about the variant origin of these arteries. Awareness of variations of the testicular arteries such as those presented here becomes important during surgical procedures like varicocele and undescended testes.
Renal arteries are a pair of lateral branches from the abdominal aorta. Normally, each kidney receives one renal artery. Variations in number, source and course of the renal arteries are common. The renal artery may give rise to branches normally derived from other vessels, such as the inferior phrenic, hepatic, suprarenal, gonadal, pancreatic and lumbar arteries . Familiarity about the possible variations in the renal arterial pattern is especially important for the personnel dealing with kidney retrieval and transplantation, various endourologic procedures and innumerable interventional techniques. In most of those situations, it is the comprehensive knowledge of the renal arterial pattern which remains the key issue in determining the technical feasibility of surgical interventions as well as the post operative management .
The anatomy of the gonadal arteries has assumed importance because of the development of new operative techniques within the abdominal cavity for operations such as varicocele and undescended testes . During laparoscopic surgery of the male abdomen and pelvis many complications are due to unfamiliar anatomy in the operative field . Awareness of variations of the testicular arteries, such as those shown in this case report, becomes important during such surgical procedures.
This vascular variation shows a major significance in renal surgery, in partial or total nephrectomy and in renal transplant. The presence of such variations may become a major risk when this type of gonadal artery represents the single blood supply of the gonad, without a second supply from the aorta or other arterial sources. Thus it becomes imperative to carefully preserve the gonadal artery in order to prevent any vascular troubles of the gonad, the genital artery being its unique source of blood supply. All these indicate the importance of the arteriography or Doppler ultrasound examination of the renal hilum, prior to any surgical procedure within the region . A case of infarction of the left testis secondary to transcatheter embolization of a malignant left renal tumor with absolute ethanol was observed by Siniluoto et al., (1988). This is probably due to the testicular artery arising from renal artery and its branches .
Lippert and Pabst (1985) pointed out that the right testicular artery originated from the right renal artery in 6% of the cases . In their study, Asala et al. (2001) found testicular arterial variations only on the right side in 4.7% (n = 150) of the cadavers . In 4 (2.6%) of these cases, testicular arteries branched from the renal artery. Onderoglu et al. (1993) reported the right testicular artery giving rise to the inferior phrenic and the superior suprarenal arteries . Cicekcibasi et al. (2002) found a gonadal artery originating from the renal artery in 5.5% of their series . Although there are reports about unilateral variant origins of testicular arteries from renal arteries [13–16], bilateral variant origin of testicular arteries from additional renal arteries is rare .
Even though presence of accessory renal arteries is not rare globally, the testicular arteries arising from the accessory renal arteries on both sides is not common. Knowledge of this variation will help to avoid clinical complications especially during radiological examination and/or surgical approaches in abdominal region.
Written informed consent was obtained from the subject's relative for publication of this case report.
We thank Dr. Surekha Bhat, Melaka Manipal Medical College for her help during preparation of the manuscript.
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