VARIATIONS OF MIDDLE SEGMENTAL ARTERY OF HUMAN KIDNEY AND CLINICAL SIGNIFICANCE

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Int J Anat Res 2015, 3(4):1551-54. ISSN 2321-4287 1551

Original Research Article

VARIATIONS OF M IDDLE SEGM ENTAL ARTERY OF HUM AN KIDNEY

AND CLINICAL SIGNIFICANCE

Gyan Prakash M ishra *

1

_{, M irza R.U. Beg}

2

_{, Shobha Bhatnagar}

3

_{, Brijendra Singh}

4

_.

ABSTRACT

Address for Correspondence: Dr. Gyan Prakash M ishra, 317, Shiv Vihar Colony, Near Divyata Palace, Sect or-I, Jankipuram, Lucknow, U.P, 226021, India.

E-M ail: gyanprakash.mishra88@gmail.com

Aim : To assess t he art erial pat t ern of m iddle segm ental art ery and it s relat ion w it h collect ing syst em in t he hum an kidneys.

M at erials and M ethods:We st udied 50 fresh hum an Kidneys by corr osion cast t echniques. We used differ ent colour coded m oulding granules of but yl but yrat e, red for ar t ery, blue for vein and black for collect ing syst em of t he hum an kidneys. 20% solut ion of but yl but yrat e in acet one w as inject ed int o r enal vessels and uret er of each kidney. Inject ed kidneys w ere kept im m ersed in concent rat ed Potassium Hydroxide solut ion for corrosion t o o bt ain t he en do cast s. These en do cast s w er e cleaned und er t he r u nn ing t ap w at er and ob ser ved m acrosco pically.

Results:We obser ved t hree t ypes of variat ions in art erial pat t er n of m iddle segm ent al art ery nam ely M iddle Segm ental Art ery Type-1 (M SAT1), M idd le Segm ent al Ar t ery Type-2 (M SAT2), M iddle Segm ental Art er y Type-3 (M SAT3) and t hey w ere seen in 29(58%), 14(28%), 6(12%) kidneys respect ively. We also observed t hree different var iat ions in relat ion bet w een m iddle segm ent al art ery and collect ing syst em nam ely M iddle Segm ent al Art ery Group-1 (M SAG1), M iddle Segm ent al Ar t ery Group-2 (M SAG2), M iddle Segm ent al Art ery Group-3 (M SAG3) and t hey w ere seen in 32%, 24%, 42% kidneys respect ively.

Conclusion:Anat om ical know ledge of t hese variat ions is of valuable cont r ibut ion for uro-surgeon in perform ing m or e and m ore conser vat ive renal surgeries w hich lead t o pr eser vat ion of healt hy and funct ional renal par enchym a and pr event int raoperat ive and post -operat ive com plicat ions.

KEY W ORDS: Kidney, M iddle Segm ental Art ery, Collect ing Syst em , Variat ions, Corrosion Cast , Conservat ive Renal Surgeries.

INTRODUCTION

Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2015, Vol 3(4):1551-54. ISSN 2321- 4287 DOI: ht t p:/ / dx.doi.org/10.16965/ ijar.2015.278

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Received: 20 Sep 2015 Accept ed: 13 Oct 2015 Peer Review : 20 Sep 2015 Published (O): 30 Nov 2015 Revised: None Published (P): 31 Dec 2015

Int ernat ional Journal of Anat omy and Research ISSN 2321-4287

ww w.ijmhr.org/ ijar.htm

DOI: 10.16965/ ijar.2015.278

1_{Associate Professor, Depart ment of Anat omy, Career Inst it ute of M edical Sciences and Hospital,}

Ghaila, Lucknow, U.P, India.

2 _{Associate Professor, Depart ment of Anat omy, M ajor SD Singh M edical College, Farrukhabad, U.P.}

India.

3_{Professor, Depart ment of Anat omy, Career Inst it ute of M edical Sciences and Hospital, Ghaila,}

Lucknow, U.P, India.

4_{Addit ional Professor, Depart ment of Anat omy, AIIM S, Jodhpur, India.}

produced during met abolic act ivit ies via urine. In the kidney urine passes t hrough minut e duct s called as collect ing syst em of nephrons. This Kidneys are chief excret ory organs in t he human

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Gyan Prakash M ishra et al. VARIATIONS OF M IDDLE SEGM ENTAL ARTERY OF HUM AN KIDNEY AND CLINICAL SIGNIFICANCE.

collect ing duct syst em is very closely relat ed w it h t he segment al renal art eries. Object ive of t he present study is t o investigat e t he variat ions in art erial pat t ern of middle segment al art ery and it s anat om ical relat ions w it h collect ing syst em of human kidneys. Graves [1] laid t he foundat ion of segment al pat t ern of int rarenal art erial dist ribut ion and it s variat ion. He divided t he renal parenchyma int o five segment s t hat w ere apical, upper, middle, low er and posterior. Kher [2 ] observed t hat ant erior division gives origin t o apical segment al art ery first and t hen t o upper, middle and low er segmental arteries. Ajmani [3] and Longia [4] st udied t he int rarenal art erial pat t ern of Kidney by cor rosion cast met hod and found variat ions in art erial pat t ern of segm ent al art eries. Anat omical know ledge about branching and relat ions of int ra-renal art eries is import ant for performing int ra-renal surgeries w it h minimal blood loss and minimal injury t o adjacent parenchyma [5].

M ATERIALS AND M ETHODS

Corrosion cast t echniques w ere used t o st udy t he det ailed anat om y of m iddle segm ent al ar t er y of hum an kidneys. We o bt ained 50 human kidneys for our st udy from t he mortuary, w it hin 24 hours of deat h. A solut ion cont aining 20 gram m oulding granules of but yl but yrat e dissolved in 100 ml acet one w as inject ed int o t he renal vessels and uret er of each kidney. Injected kidneys w ere kept immersed in 10% formal saline for polymerizat ion for a day. Next d ay t h ese ki d n ey s w er e t r an sf er r ed in t o concent rat ed Pot assium Hydroxide solut ion for corrosion, so t hat endocast s can be obt ained. Endocast s w ere cleaned under t he running t ap w at er and small branches of renal art eries w ere pruned out t o observe t he art erial pat t ern of middle segment al art ery and it s relat ion w it h collect ing syst em.

RESULTS

Type-1 (M SAT1), M idd le Segm ent al Ar t er y Type-2 (M SAT2) and M iddle Segmental Artery Type-3 (M SAT3). M SAT1 arose from ant erior division of renal art ery and seen in 29 (58%) kidneys (f igur e 1). Out of t hese in 6(12%) kidneys t he origin of t he art ery w as ext ra renal, in 18(36%) kidneys int ra renal and in 5(10%) kidneys w it hin t he hilum of t he kidney. M SAT2 arose w it h upper segment al art ery and seen in 14(28%) Kidneys (Figure 2). Out of t hese in 10(20%) Kidneys t he origin w as int rarenal and in 4(8%) kidneys at hilum . M SAT3 arose w it h low er segm ent al art ery and seen in 6(12%) kidneys (Figure 3). Out of t hese in 5(10%) kidneys t he origin w as int rarenal and in 1(2%) kidney at t he hilum. We also observed variat ions in t he r elat ion bet w een m iddle segm ent al artery and collect ing system of the kidney. These variat ions have been divided int o t hree groups nam ely M iddl e Segm ent al Ar t er y Gr ou p-1 (M SAG1), M iddle Segm ent al Art ery Group-2 (M SAG2) and M iddle Segment al Artery Group-3 (M SAG3). M SAG1 ran infront and low er half of pelvis. It w as seen in 16(32%) kidneys (Figure 2). M SAG2 ran infront and middle of pelvis. It was seen in 12(24%) kidneys (Figure 1). M SAG3 ran infront and upper half of pelvis. It w as seen in 21(42%) Kidneys (Figure 4).

Anat om ical var iat ions of m iddle segm ent al art ery w ere st udied in 50 hum an kidneys by corrosion cast t echniques. M iddle segm ent al art ery w as present and observed in 49(98%) kidneys and it was absent in 1(2%) Kidneys. We invest igat ed t he ar t er ial pat t er n of m iddle segment al art ery and observed t hree t ypes of var iat ions nam ely M iddle Segm ent al Art ery

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Fig. 2: Ant erior view show ing M iddle Segm ental Art ery Type-2 (M SAT2) and M idd le Segm ental Art ery Group-1 (M SAG1). A-Renal Art ery, C-M iddle Segm ental Art ery, D-Upper Segm ental Art er y, E-Uret er, F- Pelvis, I- Renal Vein.

Fig. 3: Ant erior view show ing M iddle Segm ental Art ery Type-3 (M SAT3). A-Renal Ar t er y, B-Ant er ior Division, C-M iddle Segm ental Art ery, E-Uret er, J-Low er Segm ental Artery.

Fig. 4: Ant erior view show ing M iddle Segm ental Art ery Group-3 (M SAG3). A-Renal Art er y, C-M idd le Segm ental Art ery, F- Pelvis, J-Low er Segm ental Art ery.

DISCUSSION

Var i at i o n s i n ar t er i al p at t er n o f m i d d l e segment al art ery have been report ed by ot her aut hors. In our st udy w e also found variat ions in it s arterial pattern. We compared our finding w it h past st udies by ot her aut hors [6-9] show n i n Tabl e 1. We also f ou nd t hr ee di f f er en t variat ions in relat ion bet w een middle segmen-t al arsegmen-t ery and collecsegmen-t ing syssegmen-t em namely M SAG1, M SAG2, M SAG3 and t hey w ere found in 32%, 24%, 42% kidneys respect ively. It is t o be noted t hat t he art erial pat t ern of middle segment al ar t er y and it s var iat ions has alr eady been report ed previously by ot her aut hors (t abulat ed in t able 1) but t he relat ion of middle segment al art ery w it h collect ing syst em has not yet been report ed and our present st udy is t he foremost t o do so. A ver y ser ious and t r oubl esom e co m p l i cat i on o f en do scop i c i n t r a-r en al operat ions is bleeding from an injured vessel and damage t o collect ing duct s of kidneys. To diminish t he risk of such injury, t he surgeon must know and recall t he spat ial posit ions of t he i nt r a-r en al v ascu lar st r u ct u r es and t hei r anat omical relat ions w it h t he collect ing syst em [ 10] . Th e kn o w l ed ge of t hese an at o m i cal relat ions and var iat ions ar e ver y usef ul f or uro-sur geon for perform ing nephrect om ies, removal of calculi or ot her various int rarenal surgeries w it h minimal complicat ions.

Table 1: Com parat ive st udy on art erial patt ern of m iddle segm en t al ar t e r y. M i d d l e Se gm e n t al Ar t er y Type -1(M SAT1), M id d le Segm ent al Ar t er y Typ e -2 (M SAT2), M iddle Segm ental Art ery Type -3 (M SAT3).

CONCLUSION

The precise know ledge of art erial pat t ern of middle segment al art ery and it s relat ion w it h collect ing syst em is of valuable cont ribut ion for su r geo n i n p er f o r m i ng m or e an d m o r e conservat ive renal surgeries li ke part ial and segment al resect ion of renal t issue inst ead of going for radical nephrect omy w hich may cause ext ensive damage and can also lead t o int raop-erat ive and post-opraop-erat ive com plicat ions like

Types Verma et al 1961 [6]

V.P. Raghavendra et al 2007 [8]

Rani Neerja et al 2014 [9]

Present study 2015

MSAT 1 72% 55% 50% 58%

MSAT 2 8% 13.33% 28%

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Int J Anat Res 2015, 3(4):1551-54. ISSN 2321-4287 1554 Conflicts of Interests: None

REFERENCES

bleeding. These conservat ive met hods can t hus lead t o preservat ion of healt hy and funct ional renal parenchyma. M oreover it is of valuable con t r ib u t io n o f dev elo p m en t o f new an d different t echniques for removal of renal calculi, sur gery f or r enal m asses and r enal t raum a management.

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VARIATIONS OF MIDDLE SEGMENTAL ARTERY OF HUMAN KIDNEY AND CLINICAL SIGNIFICANCE