Summary
Background: In the retropyelic vascularization of the kidney the a. retropyelica, the posterior terminal branch of the renal, artery, always takes its part. This artery passes through the upper edge of the renal pelvis and along its back side as a bow with an outer convexsity and after the entrance of the renal sinus it ends-up as an artery of the dorsal renal segment. By the surgical interventions on the back side of the renal pelvis i.e. by the pyelotomy it is possible to cause injury of the same as well as necrosis of a smaller or a bigger part of the renal parenchym.
Aims: For this reason we have analyzed 30 human kidneys and 80 renal angiographies.
Material and methods: Dissectional, injectional and injestion-corro- sive methods were applied. The injection-corrosive method enabled preparing anatomic models of the renal vascular system of the kidney. Were analyzed 30 human kidneys and 80 renal angiography made using contrast arteriography on Institute of radiology.
Results: We have analyzed the morphological and topographical characteristics of retropielic artery, the terminal branches of the renal artery. Retropielic artery passes trough on the back side od the renal pelvis.
Conclusion: Knowledge about the morphology, and especially topography of a. retropyelica is of major practical importance during the surgical interventions of the posterior side of renal pelvis.
Апстракт
Вовед: Во retropyelic васкуларизација на бубрезите a. retropyelica, задниот терминал гранка на артерија renalis, секогаш зема својот дел. Оваa артерија минува низ горниот раб на бубрежната карлица и по задната страна како лак со надворешен convexsity и по влезот на бубрежниот синус завршува нагоре како артерија на грбниот бубрежен сегмент. При хируршки интервенции на задната страна на бубрежната карлица, односно од страна на pyelotomy можно е да предизвика повреда на истите, како и некроза на помал или поголем дел од бубрежна паренхим.
Цели: Поради оваа причина ние ги анализиравме 30 бубрези и 80 бубрежна ангиографијии.
Материјал и методи:За дисекциите ( Dissectional), беа применети injectional и injestion-corro- сеопфатен методи. Инјекцијата-корозивен метод служи за да се подготвуват анатомски модели на бубрежна VAS-cular систем на бубрег. Беа анализирани 30 бубрези, и беа направени 80 бубрежни ангиографијии, направени со користење на контрастот за артериографија на Институтот за радиологија.
Резултати: Ги анализиравме морфолошките и топографски карактеристики на retropielic артерија, на терминалот гранки на реналната артерија. Retropielic артеријата минува низ на задната страна OD бубрежната карлица.
Заклучок: Знаење за морфологијата, а особено топографијата (topography) на retropyelica е од голема практична importance за време на хируршки интервенции на posterior страната на бубрежната карлица.
Introduction
In the retropyelic vascularization of the kidney the a. retropyelica, the posterior terminal branch of the renal artery take part. This artery passes through the upper edge of the renal pelvis and along its back side as a bow with an outer convexsity and after the entrance of the renal sinus it ends-up as an artery of the dorsal renal segment. By the surgical interventions on the back side of the renal pelvis i.e. by the pyelotomy it is possible to cause injury of the same, as well as, necrosis of a smaller or a bigger part of the renal parenchym.
Therefore knowing the topography and the morphology of the dorsal ending branch of the renal artery is of most importance and it is necessary to investigate the same; therefore it was analyzed at 30 human kidneys and at 80 renal angiographies.
Material and methods
The material for this investigation is taken from the institute of pathological anatomy and contained 30 kidneys taken post morten within 24 hours after the death from people of various ages and both sexes. We applied the inspection/dissection method, as the best procedure in the research of the autopsy material topography and injection-corrosion method, that has enabled us preparation of anatomic models of the renal artery getting a three dimensional model of its vascular network. For the injection we used diluted acrylate material. The so injected composition was subjected to corrosion into concentrated HCL – acid,
that caused corrosion and removal of the parenchym tissues from the renal network. So the received mould is suitable for topographic and morphologic research. We have also analyzed about 80 renal angiographies, made by contrast arteriography at the radiologic institute.
Results
Renal retropyelic vascularization includes a. retropyelica, the posterior terminal branch of the re-nal artery.The caliber of prepyelic branch of a. renalis is either the same or insignificantly smaller (about 1 mm ). Retropyelic artery trunk directed horizontally and more rarely ascending or descending towards the posterior edge of the renal hilus, runs backwards and above the prepyelic branch of a. renalis. Retropyelic vascularization field of renal parenchyma is smaller an the vascular field of the prepyelic artery. Of prac- cal importance is the fact that on the border between te vascular filed of the anterior and posterior teminal ranch of the renal artery there is a zone of weak ‘ascularization or “Hyrtl’s avascular line”. Along its ength, kidney incision is usually done during nephrotoumy. It is a line that stretches about 1 cm behind the external, convex edge of the kidney and divides it in two unterior and one posterior third.
Figure 1
Figure 2
Figure 3
The onset of a. retropyelica is on various distances from the renal hilus, most commonly on 2-4 cm. The trunk of the retropyelic artery crosses over the upper edge of the renal pelvis and along its posterior side in an archlike way with convexity forwards enters the kidney sinus and ends as an artery of the posterior renal segment (fig. 1). Retropyelic artery caliber is 3 mm in 70 % of the cases, the variation being 0,5 mm at most (fig 2) and (fig 3).
Discussion and conclusion
Knowledge about the morphology, and especially topography of a. retropyelica is of major practical importance during the surgical interventions of the posterior side of renal pelvis. For this reason, two surgeons – urologists Albarran (1) Garcier (2), Aristotle (3) Papin (4) dedicated great attention to this posterior branch of a. renalis. According to these autors, a.retropyelica is the constant branch of a. renalis and has smaller caliber then the prepuelic branch. Irrigation territory of retropyelic artery was studied together with the territories of the remaining branches of a. renalis by many authors Hyrtl, Zondek, Papin ( 5 ). Boskovic ( 6 ) Verma (7) Rani (8) Sampaio (9)
found that in retropyelic vascularization includes a. retropyelica and a. polaris inferior. In their papers, they have divided the kidney tissue into anterior and retropyelic vascularization areas. The border between these two areas is a vascular zone.
Knownlegde about the morphological and topographic characteristics as well as about the variation of the posterior terminal branch is of great importance for the diagnosis and practical assessment of the existing prognosis for the eventual postoperative and clinical condicion of the patient.
References
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