Anatomic variations of the renal vessels pertinent to transperitoneal vascular control in the management of trauma

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Background.Operative exposure and control of the renal vessels through a transabdominal retroperitoneal (TARP) approach has been advocated for emergency management of renal trauma. The pertinent anatomic variations of the renal vasculature have not been well described.Methods.In 190 cadavers, the renal vessels were examined. The first 20 cadavers were examined via TARP approach, and 170 cadavers were investigated after evisceration. The findings were interpreted as they might relate to the TARP approach to the renal pedicle.Results.The renal artery (RA) originated dorsally or inferiorly to the left renal vein (RV) in 70% of the cadavers on each side. Additional RAs emerging below the inferior mesenteric artery were present in 2.4% of cadavers on the right side and 1.8% on the left. Approach to the inferior vena cava (IVC) adequate for the management of trauma through the TARP approach was impossible, although it has been recommended in some research. The clinically significant incidence of variations was as follows: 47% multiple RAs, 13% multiple RVs, and 50% of at least 1 RA that coursed superior to the right RV on the right margin of the IVC.Conclusion.Knowledge of the varied anatomy of the renal vessels facilitates a safe approach to the kidneys in trauma management. The varied and unpredictable anatomy of the renal vasculature requires prompt change when the TARP approach fails to provide access to the vessels. In such cases, the colon should be mobilized promptly. On the right side of the IVC, the vessels are located so as to require clamping together almost always.

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