Normal Variants

Aberrant or accessory renal arteries may arise off the aorta or iliac arteries. They are present in up to 25% of patients, originating above or below the main renal artery (Fig. 2a, b). Accessory renal arteries will be seen coursing into the renal hilum usually perfusing the upper or lower polar regions. If an aberrant artery enters the upper or lower pole directly, without passing through the renal hilum, it is called a polar artery (Fig. 3). These aberrant

Fig. 2a, b. Renal MRA with single dose Gd-BOPTA during a 30-second breath-hold shows an occluded right renal artery (arrowsin a, b) and two left renal arteries. The superior left renal artery (ar-rowheadin a) has a moderate stenosis

Polar Renal Artery
Fig. 3. Two lower polar arteries (arrows) in a 42-year-old male with hypertension. No renal artery stenosis is present (Gd-BOPTA, 0.1 mmol/kg) [Image courtesy of Dr. G. Schneider]
Polar Arteries
Fig. 4. Renal MRA shows early branching of the right renal artery (arrow). This is a relative contraindication to donation

Fig. 5a-c. CE-MRA study of a potential living kidney donor with an accessory renal artery on the right and early branching of the left renal artery (a-c). On the whole volume MlP the additional renal artery is hard to detect (a) whereas on the subvolume reconstructions (b, c) it is clearly depicted (arrows). Note that the origin of the accessory renal artery on the left is much better appreciated on the surface rendered image (black arrow in c). (Gd-BOPTA, 0.1 mmol/kg) [Image courtesy of Dr. G. Schneider]

renal arteries may arise more anteriorly from the aorta and have a more anterior course for example coursing anterior to the IVC on the right. Early arterial branching is another common variant for which detection is necessary in patients undergoing evaluation for donor nephrectomy (Fig. 4). Branching within 2 cm of the main renal artery origin is considered "early" and may complicate harvesting as a donor kidney (Fig. 5a-c). Contrast-enhanced 3D MRA permits detailed assessment of the normal and variant vascular anatomy in most cases (Fig. 6).

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