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Prevalence and clinical relevance of the anatomical variations of suprarenal arteries: a review

  • Ananya Priya (Department of Anatomy, All India Institute of Medical Science) ;
  • Ravi Kant Narayan (Department of Anatomy, Andaman and Nicobar Islands Institute of Medical Sciences) ;
  • Sanjib Kumar Ghosh (Department of Anatomy, All India Institute of Medical Science)
  • Received : 2021.10.28
  • Accepted : 2021.11.23
  • Published : 2022.03.31

Abstract

The suprarenal arteries are arising from three sources: superior suprarenal artery, middle suprarenal artery, and inferior suprarenal artery. Variations in the arterial supply of the suprarenal glands in respect to origin and number are quite common and very frequently reported. The most common variation noted is in the inferior suprarenal artery followed by the middle suprarenal artery and the least common variations were observed in the superior suprarenal artery. Arteriogram of the inferior suprarenal artery is crucial in suprarenal tumour diagnosis but variation in the branching pattern and multiplicity of these arteries can cause hindrance in arteriography. The absence of middle suprarenal artery was seen to be associated with increased number of the inferior suprarenal artery. Variation in the multiplicity of arteries was observed more frequently in the inferior suprarenal artery and middle suprarenal artery which was more on the right side in most of the studies. Also, the variation in suprarenal arteries was often correlated to variations in inferior phrenic and gonadal arteries. The variations were observed to be more common on the left side therefore right adrenalectomy should be preferred over the left one. The loop formed by the inferior suprarenal artery around the right renal vein can cause venous obstruction. These variations of suprarenal vasculature are explained on the developmental basis, and prior knowledge of such variants is crucial for nephrologists to ensure minimum blood loss while performing laparoscopic adrenalectomy especially for large adrenal tumours and pheochromocytoma where the duration of surgery exceeds the usual.

Keywords

Acknowledgement

We are grateful to all the residents and faculty members of All India Institute of Medical Sciences, Patna for their help and co-operation during the preparation of this manuscript.

References

  1. Williams LR, Leggett RW. Reference values for resting blood flow to organs of man. Clin Phys Physiol Meas 1989;10:187-217. 
  2. Perrier ND. Suprarenal gland. In: Standring S, editor. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. London: Elsevier; 2016. p.1194-8. 
  3. Pitynski K, Skawina A, Polakiewicz J, Walocha J. Extraorganic vascular system of adrenal glands in human fetuses. Ann Anat 1998;180:361-8. 
  4. Bianchi H, Ferrari A. The arterial circulation of the left suprarenal gland. Surg Radiol Anat 1991;13:113-6. 
  5. Dutta S. Suprarenal gland-arterial supply: an embryological basis and applied importance. Rom J Morphol Embryol 2010;51:137-40. 
  6. Lakshmi KV, Dhoot M. A study on the variations of arterial supply to adrenal gland. Int J Biomed Adv Res 2016;7:373-5. 
  7. Ahmadpour S, Foghi K. Multiple absences of the branches of abdominal aorta with congenital absence of the portal vein, unilateral adrenal agenesis and persistent ductus arteriosus in a female cadaver. Anat Cell Biol 2014;47:274-8. 
  8. Gagnon R. The arterial supply of the human adrenal gland. Rev Can Biol 1957;16:421-33. 
  9. Federative Committee on Anatomical Terminology. Terminologia anatomica: international anatomical terminology. Stuttgart: Thieme; 1998. 
  10. Luna E. [On the classification of adrenal arteries]. Mon Zool Ital 1909;20:290-5. Italian. 
  11. Paitre F, Dupret S, Giraud D. [Illusional anatomosurgical practice. Fasc III- retroperitoneal organisations]. Barcelona: Salvat Editores; 1941. Spanish. 
  12. Manso JC, DiDio LJ. Anatomical variations of the human suprarenal arteries. Ann Anat 2000;182:483-8. 
  13. Diard F, Levot J, Tavernier J. [Adrenal arteriography]. Bord Med 1972;5:1435-48. French. 
  14. Lamarque JL, Jaspart W, Delylle A, Senac JP. [Angiographic radio-anatomy of the adrenals]. Ann Radiol (Paris) 1973;16:549-63. French. 
  15. Toni R, Mosca S, Favero L, Ricci S, Roversi R, Toni G, Vezzadini P. Clinical anatomy of the suprarenal arteries: a quantitative approach by aortography. Surg Radiol Anat 1988;10:297-302. 
  16. Dobbie JW, Symington T. The human adrenal gland with special reference to the vasculature. J Endocrinol 1966;34:479-89. 
  17. Sushma RK, Dhoot M, Harode HA, D'Souza AS, Mamatha H. Anatomical variations in the arterial supply of the suprarenal gland. Int J Health Sci Res 2014;4:31-6. 
  18. Sarkar M, Mukherjee P, Roy H, Sengupta SK, Sarkar AN. An unusual branch of celiac trunk feeding suprarenal gland - a case report. J Clin Diagn Res 2014;8:AD03-4. 
  19. Shanthakumar RS, Kumar N, Badagabettu SN, Kappettu Gadahad MR, Reghunathan D, Patil J. Rare combined variation of left suprarenal vessels associated with retroaortic left renal vein. Proc Singap Healthc 2016;25:112-4. 
  20. Ahmed MM, Reddy MV, Suresh S, Naaz A. The mystery around suprarenal gland- dispelled! IOSR J Dent Med Sci 2015;14:12-9. 
  21. Chakravarthi KK. Unilateral multiple variations of renal, phrenic, suprarenal, inferior mesenteric and gonadal arteries. J Nat Sci Biol Med 2014;5:173-5. 
  22. Olewnik L, Wasniewska A, Polguj M, Topol M. Rare combined variations of renal, suprarenal, phrenic and accessory hepatic arteries. Surg Radiol Anat 2018;40:743-8. 
  23. Reddy MV, Ahmed MM, Kumar PP, Raghuramaiah G. A study on vasculature of the suprarenal glands. Int J Anat Res 2014;2:195-201. 
  24. Ozturk NC, Uzmansel D, Kara A, Ozturk H. Variation in the position, relation and vasculature of left suprarenal gland: a case report. Surg Radiol Anat 2010;32:985-8. 
  25. Anupama D, Prabha Subhash RL, Suresh BS. Inferior phrenic artery, variations in origin and clinical implications- a case study. IOSR J Dent Med Sci 2013;7:46-8. 
  26. Reddy S, Bhat SM, Mathew JG, Shetty PC, Gorantla VR, Jetti R, Vollala VR. A common trunk of origin of the right testicular and middle suprarenal arteries with a retrocaval course. Indian J Surg 2011;73:314-5. 
  27. Greeff B, Pillay P, De Gama BZ, Satyapal KS. An anatomical investigation of the vascular supply of the suprarenal glands in fetuses. Int J Morphol 2019;37:1023-32. 
  28. Honma S, Kudo M. The middle suprarenal artery arising from the superior mesenteric artery. Surg Radiol Anat 2012;34:93-5. 
  29. Yalcin B, Kocabiyik N, Yazar F, Ozan H, Ozdogmus O. Variations of the branches of the celiac trunk. Gulhane Tip Dergisi 2004;46:163-5. 
  30. Cimen M, Erdil FH, Kosar MI, Sabanciogullari V. A rare variation of the right middle suprarenal artery. Ann Anat 2007;189:287-9 
  31. Deepthinath R, Satheesha Nayak B, Mehta RB, Bhat S, Rodrigues V, Samuel VP, Venkataramana V, Prasad AM. Multiple variations in the paired arteries of the abdominal aorta. Clin Anat 2006;19:566-8. 
  32. Bakheit MA, Motabagani MA. Anomalies of the renal, phrenic and suprarenal arteries: case report. East Afr Med J 2003;80:497-8. 
  33. Brohi RA, Sargon MF, Yener N. High origin and unusual suprarenal branch of a testicular artery. Surg Radiol Anat 2001;23:207-8. 
  34. Nayak SR, J JP, D'Costa S, Prabhu LV, Krishnamurthy A, Pai MM, Prakash. Multiple anomalies involving testicular and suprarenal arteries: embryological basis and clinical significance. Rom J Morphol Embryol 2007;48:155-9. 
  35. Suoranta H, Pietila K. An aberrant origin of the inferior suprarenal arteries associated with renal agenesis. J Urol 1974;112:428-9. 
  36. Jyothsna P, Mohandas Rao K, Somayaji S, Ashwini L. Multiple vascular anomalies involving testicular, suprarenal arteries and lumbar veins. N Am J Med Sci 2012;4:154-6. 
  37. Vinitha G, Parthasarathy M. Anatomical variant origin of suprarenal arteries from coeliac trunk development, and its clinical significance. Int J Res Med Sci 2020;8:460-3. 
  38. Bordei P, St Antohe D, Sapte E, Iliescu D. Morphological aspects of the inferior suprarenal artery. Surg Radiol Anat 2003;25:247-51. 
  39. Hureau J, Hidden G, Minh TT. The vascularization of the suprarenal glands. Anat Clin 1980;2:127-46. 
  40. Hagopian AC. An abnormal inferior suprarenal artery. Yale J Biol Med 1953;26:78-9. 
  41. Rossi P, Passariello R, Simonetti G, Rovighi L, Crecco M. Arterious and venous system of the adrenal glands: anatomical considerations. Ann Radiol (Paris) 1979;22:372-7. 
  42. Xu R, Zhu Z, Tang W, Zhou Q, Zeng S. Zone-specific reference ranges of fetal adrenal artery Doppler indices: a longitudinal study. BMC Pregnancy Childbirth 2020;20:774. 
  43. Miekos E. Anatomical basis of radiodiagnosis of the adrenal gland. Int Urol Nephrol 1979;11:193-200. 
  44. Mazza E. [Anatomical research on adrenal arteries in humans]. Minerva Chir 1954;9:175-81. Italian. 
  45. Levi G. [Variations of the adrenal and renal arteries studied with the serial statistical method]. Arch Ital Anat Embriol 1909;8:35-71. Italian. 
  46. Felix W. Mesonephric arteries (aa mesonephricae). In: Keibel LF, Mall FP, editors. Manual of Human Embryology. Philadelphia: Lippincott; 1912. p.820-5. 
  47. Hochstetter F. [Contributions to the development history of the vein system of the amniotics. III. Mammal]. Morp Jb 1893;20:543-648. German. 
  48. Abe H. [First of the evolution of the angiosistemo de la reno cˆe ham- steroj]. Kaibogaku Zasshi 1956;36:677-99. Esperanto. 
  49. Salama J, Folio P, Chevrel JP. [Reconstruction of the metanephros of a human embryo of 20 millimeters. Study of the origin of the renal artery]. Bull Assoc Anat (Nancy) 1982;66:397-406. French. 
  50. Isogai S, Horiguchi M, Hitomi J. The para-aortic ridge plays a key role in the formation of the renal, adrenal and gonadal vascular systems. J Anat 2010;216:656-70. 
  51. Hinata N, Suzuki R, Ishizawa A, Miyake H, Rodriguez-Vazquez JF, Murakami G, Fujisawa M. Fetal development of the mesonephric artery in humans with reference to replacement by the adrenal and renal arteries. Ann Anat 2015;202:8-17. 
  52. Turyna R, Kachlik D, Feyreisl J, Stingl J, Baca V. Anterior retroperitoneal rami: until now unnamed direct branches of the abdominal aorta. Clin Anat 2014;27:894-9. 
  53. Gerhardt H, Golding M, Fruttiger M, Ruhrberg C, Lundkvist A, Abramsson A, Jeltsch M, Mitchell C, Alitalo K, Shima D, Betsholtz C. VEGF guides angiogenic sprouting utilizing endothelial tip cell filopodia. J Cell Biol 2003;161:1163-77. 
  54. Ucuzian AA, Gassman AA, East AT, Greisler HP. Molecular mediators of angiogenesis. J Burn Care Res 2010;31:158-75. 
  55. Djonov VG, Galli AB, Burri PH. Intussusceptive arborization contributes to vascular tree formation in the chick chorioallantoic membrane. Anat Embryol (Berl) 2000;202:347-57.