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Background: Renal vascular variants may complicate the surgical techniques of living related renal transplantation. Renal computed tomographic (CT) angiography is now well accepted for preoperative renal vascular mapping in living related renal donors., Objective: To study the prevalence of renal vascular variants in living related renal donors using CT angiography., Material and Method: Preoperative renal CT angiography of 65 consecutive living related renal donors were retrospectively reviewed by two abdominal radiologists on a 3-D workstation. The number and branching patterns of bilateral renal arteries and veins, as well as the presence of renal arterial and venous variants were described., Results: Supernumerary renal arteries and early branching were present in 18.5% and 12.8% respectively on the right kidneys and 27.7% and 22.4% respectively on the left kidneys. The prevalence of precaval right renal artery was 4.6%. Supernumerary renal veins were present in 35.4% and 1.5% on the right and left kidneys, respectively. Late confluences of left renal veins were identified in 1.5% of left kidneys. Other venous anomalies included 1.5% duplicated inferior vena cava (IVC), 1.5% circumaortic left renal vein, 1.5% retroaortic left renal vein, 1.5% outsized left gonadal veins drained into the left renal vein, and 6.2% right gonadal vein drained into the right renal vein., Conclusion: Renal vascular anatomical variants were common. The surgeons and the radiologists should be aware of these variants to prevent postoperative complications.

Objective: Using 16-MDCT, we describe and quantify the frequency and types of renal anatomic variants and findings relevant for preoperative evaluation and surgical planning for potential laparoscopic renal donors., Materials and Methods: On 16-MDCT, 126 consecutive potential donors underwent scanning before contrast administration and after i.v. power injection of nonionic contrast material during the arterial, nephrographic, and excretory phases. On a 3D workstation, CT images were evaluated retrospectively in consensus by three abdominal imagers. The number and branching pattern of bilateral renal arteries and veins, including anomalies of the inferior vena cava and lumbar-gonadal axis, were categorized along with the frequency of incidental findings of the renal parenchyma and collecting system., Results: Major arterial variants including supernumerary and early branching arteries were present in 16% and 21%, respectively, of left kidneys and 22% and 15%, respectively, of right kidneys. Major and minor venous variants were detected in 11% and 58% of left kidneys and 24% and 3% of right kidneys. Late confluence of the venous trunk was identified in 17% of left kidneys and 10% of right kidneys. Incidental parenchymal and urothelial abnormalities, most commonly cysts and calyceal calcifications, were identified in 30% of the kidneys. Other relevant incidental findings included focal infarcts, cortical scars, atrophic scarred kidney, and bilateral papillary necrosis. Urothelial variants included bilateral simple ureteroceles and rightsided complete duplicated collecting system., Conclusion: 16-MDCT angiography and urography allow confident detection and classification of a variety of anatomic and incidental anomalies relevant to the preoperative selection of potential laparoscopic renal donors and to surgical planning.

Objective: Our objective was to determine the efficacy of 16-MDCT angiography in preoperative evaluation of vascular anatomy of laparoscopic renal donors., Methods and Materials: Fifty-five consecutive renal donors (25 men and 30 women) underwent 16-MDCT angiography followed by donor nephrectomy. In the arterial and nephrographic phases, images were acquired with 60% overlap and 0.6-mm reconstruction in both phases after 120 mL of iohexol was injected at 4 mL/sec. On a 3D workstation, images were evaluated retrospectively by two abdominal imagers blinded to surgical results with respect to number and branching pattern of renal arteries and major and minor renal veins. These CT angiography results were compared with surgical findings., Results: The surgically confirmed sensitivity of both reviewers (1 and 2) using the MDCT data for detection of renal arteries was 98.5% (65 of 66), and accuracies were 97.0% for reviewer 1 and 95.5% for reviewer 2. Sensitivity and accuracy detection of renal veins was 97% (61 of 63) and 98% (62 of 63) for reviewer 1 and reviewer 2, respectively. Sensitivity and accuracy detection of early arterial bifurcation (< 2 cm from aorta) was 100% (14 of 14), and sensitivity in detection of late venous confluence (< 1.5 cm from aorta) was 100% (8 of 8). All major renal venous variants were identified; reviewer 1 identified 78% (18 of 23) minor venous variants, and reviewer 2 identified 83% (19 of 23) minor venous variants. There were no hemorrhagic complications at surgery. Excellent agreement between reviewers (kappa = 0.92-0.97) was achieved for detection of normal and variant anatomy., Conclusion: 16-MDCT angiography enabled excellent preoperative detection of arterial anatomy and venous laparoscopic donor nephrectomy.