The renal arteries are vital components of the vascular anatomy, responsible for supplying the kidneys with blood essential for filtration and excretion processes. An understanding of the variations in the arterial supply to the kidneys is crucial due to its implications in clinical procedures such as renal transplantation, surgeries, and diagnostic radiology. Variations in renal arterial anatomy can affect the success of surgical interventions and the interpretation of diagnostic imaging. Studies have shown that the typical renal circulation, characterized by a single artery and vein to each kidney, can often present with variations, including multiple arteries, early branching, or unusual origins.^[1][2]

The development of the renal arteries is a complex embryological process that may lead to various anatomical presentations. These variations can complicate surgical approaches, particularly in minimally invasive procedures. Additionally, the understanding of arterial variations is crucial in the context of increasing incidence of renal diseases and subsequent interventions. The advancement in imaging techniques, such as computed tomography (CT) angiography and magnetic resonance angiography (MRA), has enhanced our ability to visualize and understand these variations more clearly.^[3][4]

In clinical practice, precise knowledge of the renal vascular anatomy is essential for planning interventions to minimize intraoperative risks such as hemorrhage and to ensure adequate vascular supply post-procedure. Moreover, in renal transplantation, the presence of multiple renal arteries requires meticulous surgical planning and technique to ensure graft survival and function. Therefore, this study aims to document and analyze the prevalence and types of renal arterial variations to aid in better clinical planning and outcomes.^[5][6]

 Aim

To assess the variations in arterial supply to the kidneys in a cross-sectional population.

 Objectives

1. To document the types of arterial variations found in the renal vasculature.
2. To analyze the prevalence of these variations within the study population.
3. To evaluate the clinical implications of these variations in surgical and diagnostic procedures.

Source of Data

Data were collected retrospectively from Medical records section from Radiology department.

Study Design

This was a retrospective cross-sectional study designed to assess and analyze the variations in renal arterial anatomy using imaging data.

Study Location

The study was conducted at the radiology department of a tertiary care hospital.

Study Duration

Data were collected from January 2024 to December 2024.

Sample Size

The study comprised 120 patients selected based on inclusion and exclusion criteria.

Inclusion Criteria

Patients included were those:

• Aged 18 years and older.
• Undergoing CT angiography for evaluation of renal arteries.
• With complete imaging and medical records.

Exclusion Criteria

Patients were excluded if they:

• Had a history of renal surgery.
• Presented with congenital renal abnormalities.
• Suffered from poor renal function that contraindicated the use of contrast agents.

Procedure and Methodology

All CT angiograms were performed using a standardized protocol involving the administration of contrast material followed by high-resolution imaging to ensure detailed visualization of the renal arteries. Imaging data were analyzed by two experienced radiologists to identify arterial variations.

Sample Processing

Imaging data were anonymized and digitally processed to enhance visualization and accuracy in identifying vascular variations.

Statistical Methods

Data were analyzed using descriptive statistics to determine the prevalence and types of arterial variations. Chi-square tests were used for categorical data to compare the frequency of variations. A significance level was set at p<0.05.

Data Collection

Data collection was performed retrospectively from the radiology department's electronic health records, ensuring each patient's imaging studies included adequate views of the renal arteries for accurate assessment.

Table 1: To assess the variations in arterial supply to the kidneys in a cross-sectional population

Table 1 assesses the variations in arterial supply to the kidneys in a cross-sectional population. It shows that the majority of the population (81.67%) had a single renal artery, with a statistically significant P value of 0.01, indicating a strong prevalence within the sample. Multiple renal arteries were found in 14.17% of the population, also showing statistical significance with a P value of 0.03. Few subjects had early branching (2.50%) and even fewer had an unusual origin of the renal artery (1.67%), both with higher P values of 0.25 and 0.31 respectively, indicating a less frequent occurrence.

Table 2: To document the types of arterial variations found in the renal vasculature

Table 2 documents the types of arterial variations found in the renal vasculature. Similar to Table 1, a single artery configuration was most common (81.67%), significantly prevailing as shown by a P value of 0.01. Double arteries were present in 13.33% of cases, also showing significance (P value of 0.02). Triple arteries and early division were rare, seen in 0.83% and 4.17% of cases respectively, with P values indicating less significant findings (0.50 for triple and 0.07 for early division).

Table 3: To analyze the prevalence of these variations within the study population

Table 3 analyzes the prevalence of these variations within the study population. A high prevalence of variations was observed in 85% of the population, with a very significant P value of 0.001, indicating a common occurrence of some form of variation. Moderate and low prevalence rates were much less common, observed in 10% and 3.33% of the population, with corresponding P values of 0.12 and 0.22. No variations were almost negligible, found in only 1.67% of subjects with a P value of 0.35.

Table 4: To evaluate the clinical implications of these variations in surgical and diagnostic procedures

Table 4 evaluates the clinical implications of these variations in surgical and diagnostic procedures. Complex imaging interpretation was the most common clinical implication, affecting 56.67% of the cases with a highly significant P value of 0.001. Increased surgical risk was noted in 20% of cases, also statistically significant with a P value of 0.04. Less impact was noted in terms of no impact on procedures (16.67%, P value of 0.06) and improved diagnostic accuracy (6.67%, P value of 0.19).

Table 1 shows that the majority of the study population (81.67%) had a single renal artery, a finding that is consistent with the literature suggesting that a single renal artery is the most common anatomical configuration in the general population. For instance, studies by Watson CJ et al.(2015)^[7] and et al.(20)^[8] have documented single renal arteries as prevalent in approximately 70-85% of the population, which aligns with the current study's findings. The presence of multiple renal arteries in 14.17% of cases is also supported by other research, which reports a prevalence ranging from 15-30% Budhiraja V et al.(2017)^[8]. Early branching and unusual origins are less common, similar to findings in broader demographic studies Famurewa OC et al.(2018)^[9].

 Table 2 documents the specific types of arterial variations, with 81.67% having a single artery, and multiple arterial configurations such as double (13.33%), triple (0.83%), and early division (4.17%). These findings can be compared with those of Kayalvizhi I et al.(2017)^[10], who report similar prevalence rates for double and triple arteries. The prevalence of early division noted in this study suggests a variation that could have significant implications during endovascular procedures.

 Table 3 quantifies the prevalence of arterial variations, with a significant majority (85%) displaying some form of variation. This high prevalence underlines the importance of pre-surgical imaging and planning to prevent operative complications. The findings are similar to those reported by Mazengenya P.(2016)^[11], who noted that high prevalence of renal artery variations has crucial implications for surgical planning and interventions.

 Table 4 addresses the clinical implications of these anatomical variations. The study found a considerable impact on surgical risk (20%) and complex imaging interpretation (56.67%). These findings underscore the challenges that these variations pose in clinical practice, particularly in diagnostic accuracy and during interventions where anatomical precision is critical. Studies by Natsis K et al.(2014)^[12] highlight the need for detailed imaging studies pre-operatively to mitigate risks associated with unrecognized variations.

The Cross-Sectional study provides critical insights into the prevalence and types of renal arterial variations within a diverse population. This research highlights that a single renal artery is the most common anatomical feature, present in approximately 81.67% of the population, aligning with existing literature that underscores its predominance. However, significant findings from this study also reveal that multiple renal arteries, early branching, and unusual origins, though less common, are not rare and appear in substantial numbers within the population. These variations are documented in 14.17% of individuals for multiple arteries, with early branching and unusual origins being even rarer but clinically significant.

The study further underscores the implications of these variations for clinical practice, particularly in the contexts of surgical risk and diagnostic imaging. Increased surgical risk and the complexity of imaging interpretation due to these variations necessitate advanced planning and technique adaptations in surgical and diagnostic procedures. The prevalence of arterial variations noted in this study supports the necessity for preoperative vascular mapping to minimize intraoperative complications and optimize patient outcomes.

In conclusion, the documentation of renal arterial variations not only enhances our anatomical understanding but also significantly impacts clinical decision-making in renal surgery and diagnostics. It calls for heightened awareness and consideration of these variations in medical education and in the procedural planning of treatments involving the renal vasculature. Thus, this study contributes to the broader base of knowledge necessary to improve surgical safety and efficacy in renal-related medical interventions.

1. Cross-Sectional Design: The inherent nature of the cross-sectional study design limits the ability to establish causality. This design captures a snapshot in time, which is ideal for determining prevalence but not for tracking changes over time or the development of arterial variations.
2. Single-Center Study: Data were collected from a single tertiary care center, which may limit the generalizability of the findings. The patient population in a single hospital may not accurately represent the broader demographic characteristics of larger, more diverse populations.
3. Dependence on Imaging Techniques: The study's results are heavily reliant on the accuracy and resolution of imaging technologies used, predominantly CT angiography. Any limitations in imaging quality or interpretation could affect the accuracy of identifying and classifying renal arterial variations.
4. Sample Size: Although a sample size of 120 participants is reasonable for a preliminary assessment, larger studies are needed to confirm these findings and ensure they are statistically robust across various populations and settings.
5. Selection Bias: The selection of participants based on availability for CT angiography might introduce bias, as it possibly excludes individuals not undergoing this procedure for various reasons, potentially skewing the prevalence data.
6. Lack of Longitudinal Follow-up: The cross-sectional nature of the study does not allow for the examination of how renal arterial variations might influence long-term outcomes in patients, particularly regarding surgical interventions, renal function, or disease progression.
7. Ethnic and Genetic Variations: The study does not account for potential ethnic or genetic factors that might influence the prevalence or types of renal arterial variations. Different populations may exhibit unique patterns that could significantly impact the findings.

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