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Journal of the Anatomical Society of India

Variations In Renal And Testicular Veins – A Case Report

Author(s): Sharmistha Biswas, J.C.Chattopadhyay, H. Panicker, J. Anbalagan , S.K.Ghosh

Vol. 55, No. 2 (2006-07 - 2006-12)

Sharmistha Biswas, J.C.Chattopadhyay, H. Panicker, J. Anbalagan , S.K.Ghosh
Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, M.H.

Abstract:

This study reports the presence of an additional renal vein on the right side draining directly into IVC. This variation was observed during a routine dissection in a middle-aged male cadaver. On further dissection it was seen that this additional vein received the right testicular vein. Both the renal veins of the right side had a normal course, lying anterior to the renal artery and ureter. On the left side, two veins were coming out from the upper and lower ends of the hilum and they joined to form a single left renal vein, which passed in front of the aorta. The lower tributary of the left renal vein rather than the left renal vein received the testicular vein of the left side.

These variations are of immense importance because its implications in renal transplantation, renal surgeries, uroradiology and testicular /gonadal surgeries. Thus the knowledge of these variations could help the clinicians in its recognition and protection. Embryological basis of this variation is discussed.

Key words: additional renal vein, testicular vein, renal transplantation.

Introduction:

Presence of additional renal vein has been reported to occur in 14% cases (Rupert, 1915; Pick ∓ Anson, 1940; Satyapal, 1995). Satyapal (1995) has named any extra vein other than renal vein emerging out of kidney and draining separately in the Inferior Vena Cava as “additional” renal vein, and classified these kidneys as Type 3, using the drainage pattern of primary renal vein tributaries and renal vein proper as a basis. Reviewing articles we found there were ten fold increases in the number of additional renal vein in the right side as compared to that of the left side (Satyapal, 1995; Pick & Anson, 1940; Merklin ∓ Michel, 1958). Right testicular vein draining into right renal vein rather than inferior vena cava was reported in 2 out of 150 cadavers dissected by Asala et al, (2001). Very few literatures exist citing the anatomical variations of both renal and gonadal veins. Because of practical importance of such variations in renal transplantation, renal and gonadal surgeries, uroradiology, gonadal/testicular colour Doppler imaging and other retroperitoneal therapeutic and diagnostic procedures, the present case is reported.

Case Report

During routine dissection of a middle- aged male cadaver certain variations in the renal and testicular veins were observed.

On the right side, there was an additional renal vein that drained directly into the inferior vena cava. This right additional renal vein receives the right testicular vein, which normally drains into the inferior vena cava. (fig. 1)

In the left side, there were two veins coming out from the upper and lower borders of hilum and they joined to form the main left renal vein, which passed in front of the aorta. The lower vein rather than the main left renal vein received the testicular vein of the left side. (fig. 1).

Fig. 1: The photograph shows bilateral variations in the renal and testicular veins.

  1. Right additional renal vein (RARV) draining directly into IVC
  2. Right additional renal vein (RARV) receiving rieght testicular vein (RTV)
  3. Formation of left renal veing (LRV)
  4. Left testicular veing (LTV) draining into lower tributary of left renal veing (LLRV)

Discussion:

Anatomical variations of renal and gonadal venous arrangements are of immense clinical importance. In the present study we found an additional right renal vein in which right testicular vein was draining. On the left side, upper and lower primary renal vein tributaries were present. These findings were noticed in one out of twenty four cadavers dissected over a period of five years, from 1998 to 2003.

Satayapal (1995) reported that incidence of additional right renal vein was 26% as compared to 2.6% on the left side, while Pick & Anson series (1940) reported 27.8% additional veins on right side. Pollak et al (1986) also observed that additional renal veins and other venous variations are more common on the right side. Moreover, an anomaly on one side was not predictive of finding an anatomical variant in contralateral kidney. Ross et al (1961) emphasized the importance of such variations. Both the recovery and implant surgeon should be conversant with the anatomical variants of cadaver kidneys procured for renal transplantations. They commented that incidence of additional renal vein may contribute to the criteria adopted to select a donor kidney suitable for transplantation

Additional renal vein may act as an alternate collateral route if the inferior vena cava has been interrupted between these veins (Greweldinger et al, 1969).Several authors like Anson et al (1936) who had reported that the right renal vein rarely received tributaries, whereas left renal vein regularly had complex connections with other venous channels, which wre the basis of collateral pathways after caval interruption.

Variations of gonadal veins were more frequent on the left side, as observed by Asala et al (2001), who found only 2 cases of right gonadal vein draining into right renal vein out of 150 cadavers dissected. The testes are important organs whose veins and arteries play major role in their thermo-regulation that is essential for efficient functioning of the organs. Thus variations of testicular venous drainage are very significant while performing surgery or radiology. During endo-urological procedures, anatomical variations of renal and gonadal veins have got immense significance, as lesions in them may cause severe back bleeding during and after surgery. These variations may remain clinically silent and usually unnoticed until discovered during operation or autopsy (Hoeltlet al 1990)

A significant finding in this present case is draining of right testicular vein into the right additional renal vein.

Embryological Basis:

During development of inferior vena cava, the “renal collar” form a circum aortic venous ring, being contributed anteriorly by subcardinal veins and inter subcardinal anastomosis, posteriorly by supracardinal veins and inter supracardinal anastomosis, and on each side by supracardinal-subcardinal anastomosis (Williams et al, 1995).It is identifiable at a 15mm stage embryo. In 22mm long embryo, after definitive position of metanephros has been attained, permanent venous pattern begins to appear (McClure & Butler, 1925). The bilaterally symmetrical cardinal venous system converts into unilateral right-sided inferior vena cava at around 8 wks. IVC is established in the right of aorta consequent to this “venous shift” to the right of the body. At this time, two renal veins are present on each side, one on the ventral plane and another dorsal to it. In the right side, one renal vein opens into the lateral portion of the renal collar and the other opens more dorsally towards cranial part of the supracardinal vein. With further development, there is confluence of the two tributaries producing a single vessel that connects with the lateral portion of renal collar. The persistence of these two veins may result in the additional renal vein of right side as seen in present case. These shifting of venous arrangement to the right “discourage” the retention of any additional left sided renal veins, which would be required to reach across the aorta. Furthermore, complex embrogenesis of left renal vein would further “discourage” this process. Since right side is free of these impediments, additional right renal vein may be retained. Hence presence of additional Right renal vein is much more common than the left side.

Gonadal vein develops from caudal part of subcardinal vein and it drains into the supra-subcardinal anastomosis. In the right side, this supra-subcardinal anastomosis and also a small portion of Subcardinal vein are incorporated into the formation of inferior vena cava, so right gonadal vein usually drains into the inferior vena cava. In this present case this failed and a part of right renal vein was formed by right supra-subcardinal anastomosis and hence received the right testicular vein. In the left side, this suprasubcardinal anastomosis forms part of left renal vein where the left gonadal vein drains, and the pre-aortic part of the vein is formed by inter-subcardinal anastomosis. In the present case proximal part of the two original metanephric veins persisted.

References:

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  14. Williams et al: Gray’s Anatomy,. In: Embryology and Development, 38 th Edn; Churchill Livingstone, London, 1995; pp324-326.
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