Angio CT assessment of anatomical variants in renal vasculature: its importance in the living donor

BACKGROUND: Renal vasculature is known for having a broad spectrum of variants, which have been classically reported by anatomists. METHODS: The distribution and morphology of these variations can be explained by considering the embryology of the renal vessels. With the recent outburst of imaging techniques, it has been the radiologist’s turn to take the baton, recognising and describing unconventional renal vascular patterns. RESULTS: Knowledge of these patterns has gained significance since the advent of the era of transplantation. For almost 60 years cadaveric donation has been the main source of kidneys suitable for transplantation. Living kidney donation demonstrates many advantages and stands out as the best alternative for organ procurement to meet the increasing demand. Since the dawn of laparoscopic nephrectomy as the technique of choice for organ procurement in living kidney donors, MDCT plays a key role as a noninvasive preoperative planning method for anatomic evaluation. As the field of view at laparoscopic surgery is limited, it is essential to meticulously assess the origin, number, division and course of arteries and veins. CONCLUSION: Awareness of the different anatomical variants allows the radiologist to enlighten the surgeon in order to avoid compromising the safety of the surgical procedure that could lead to significant complications. TEACHING POINTS: Renal vasculature has many variants, which can be explained by considering the embryology of kidneys. Living kidney donation demonstrates many advantages over cadaveric donation. Angio CT evaluation of living kidney donors is a multiple phase study. A detailed report describing the variants, their distribution and morphology will help surgeons.