Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 331-333  

Arched abdominal aorta and altered course of right ovarian vessels in a female cadaver: Clinical significance and embryological explanation


Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Web Publication5-Jul-2013

Correspondence Address:
Sneha Guruprasad Kalthur
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.114681

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  Abstract 

Variations in the vascular origin of ovarian artery have been reported in the past. However, the reports on altered course of ovarian artery are very few. In the present paper, we discuss about multiple variations observed in formalin fixed female cadaver. The right ovarian artery was 22 cm long and ran unusually behind the inferior vena cava (IVC). The right ovarian vein drained in to right renal vein at right angle instead of draining into IVC directly. In addition, to these variations, the cadaver had arched abdominal aorta and retro-aortic left renal vein.

Keywords: Abdominal aorta, left renal vein, ovarian artery, retro-aortic vein


How to cite this article:
Kalthur SG, Siddaraju K S, D'Souza AS. Arched abdominal aorta and altered course of right ovarian vessels in a female cadaver: Clinical significance and embryological explanation. Med J DY Patil Univ 2013;6:331-3

How to cite this URL:
Kalthur SG, Siddaraju K S, D'Souza AS. Arched abdominal aorta and altered course of right ovarian vessels in a female cadaver: Clinical significance and embryological explanation. Med J DY Patil Univ [serial online] 2013 [cited 2019 Dec 12];6:331-3. Available from: http://www.mjdrdypu.org/text.asp?2013/6/3/331/114681


  Introduction Top


Variations in the origin and course [1],[2] of ovarian arteries have been reported earlier. Right gonadal arteries (RGA) arising below [3] or above the level of the left renal vein (LRV) [4],[5] and subsequently passing ventrally or dorsally to the inferior vena cava (IVC) are common. Variation in the course of gonadal vessels is of clinical significance in treatment of renal surgeries such as renal transplantation, renovascular hypertension, renal artery embolization, angioplasty or vascular reconstruction for congenital and acquired lesions and surgery for abdominal aortic aneurysm. [6] In the present study, we report the multiple vascular anomalies observed in the formalin fixed female cadaver with emphasis on the embryological aspects.


  Case Report Top


During routine dissection of the retroperitoneal region of a formalin fixed female cadaver (55 years old) while teaching the medical students in Department of Anatomy, we observed The right ovarian artery (ROA) arose from the abdominal aorta (AA) just 0.3 cm inferior to right renal artery and 1 cm cranial to LRV which was retro-aortic in position. ROA however, had an unusual course. It passed posterior to IVC and ran on psoas major muscle accompanied by the ovarian vein (OV). Inside the pelvic brim it had a normal course and branching pattern. Interestingly, right OV drained in to right renal vein (RRV) instead of draining in to IVC. Furthermore, we observed deviation of AA 2.7 cm away from IVC as it descended downwards, which was seen distal to renal artery [Figure 1].
Figure 1: Variation in course of right ovarian vessel, left renal vein and abdominal aorta

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  Discussion Top


Variation in the origin of ovarian artery has been reported earlier in the literature. [1],[2] However, the reports on abnormal course of ovarian artery are very few. [5] Generally, the variations of ovarian artery are unilateral with high incidence of variation on the left side.

Gonadal arteries arise from AA caudal to renal arteries but their relation with LRV may vary. They can lie either cranial or caudal or may lie at the level of LRV and this is of significance because of their unique placement. [2] The incidence of RGA arising above LRV varies from 1.3% to 6%. [2],[5] In all these cases ROA was passing dorsally to IVC. This formation of retrocaval passage of the gonadal artery is thought to be due to embryological development of IVC.

During development, one of the lateral splanchnic branches of dorsal aorta persists as gonadal artery, which later enters the mesonephros by crossing supracardinal and subcardinal veins either ventrally or dorsally. Anastomosis between supracardinal and subcardinal veins, which gives rise to part of IVC, is of utmost importance as they determine the course of the RGA. [7] In the present case ROA must have passed dorsal to either subcardinal and supracardinal veins or dorsal to subcardinal and ventral to the supracardinal veins during embryonic stage of development. As subcardinal vein forms IVC at this position the dorsally placed ROA will lie behind IVC [Figure 2].
Figure 2: (a-c) Proposed scheme for formation of type III RGA (RSPV - Right supracardinal vein; RSCV - Right subcardianl vein; AA - Abdominal aorta; RGA - Right gonadal artery; LGA - Left gonadal vein; LSPV - Left supracardinal vein; LSCV - Left subcardianl vein; RSSA - Right supra-subcardinal anastomosis; LSSA - Left supra-subcardinal anastomosis; vSCA - Ventral subcardianal anastomosis; dSPA - Dorsal supracardinal anastomosis; IVC - Inferior vena cava; ROV - Right ovarian vein; LOV - Left ovarian vein; RRV - Right renal vein; LRV - Left renal vein)

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OVs are known to show variation in the pattern of their termination. [8] Gonadal vein develops from caudal part of subcardinal vein and drains into the supra-sub-cardinal anastomosis, which on right side forms part of IVC but on left side this anastomosis forms LRV. In the present case, may be part of supra-sub-cardinal anastomosis failed to get incorporated in to IVC and formed a part of RRV was and hence the RRV received the right OV [Figure 2].

Retro-aortic renal vein develops when the dorsal part of renal collar persists instead of ventral. Renal collar, circumaortic ring, is formed by subcardinal veins and inter subcardinal anastomosis (anteriorly), supracardinal veins and inter supracardinal anastomosis (posteriorly), supracardinal-subcardinal anastomosis (on either side). [7] In the present case, the LRV lies dorsal to AA. This must be due to persistence of inter-supracardinal anastomosis, which is post-aortic leading to formation of retro-aortic renal vein [Figure 2]. The retro-aortic vein becomes especially, important during repair of an abdominal aortic aneurysm, where the aorta has to be mobilized or kidney. [9],[10] Furthermore, the retro-aortic LRV may get compressed in between the AA and lumbar spine producing impaired backward venous pressure leading to renal hypertension.

A thorough knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of radical renal surgery, angioplasty or vascular reconstruction for congenital and acquired lesions and surgery for abdominal aortic aneurysm. In general, the variations in the origin, course and branching of gonadal vessels and renal veins are attributed to development of the IVC, which has composite origin, which involves the anastomosis of the posterior cardinal vein, subcardinal veins, and supracardinal veins. The deviation of AA must be due to changes in the hemodynamic circulation (leading to aneurysm commonly affecting below the level of kidney). Knowledge of these common variations will serve as a reference for avoiding clinical complications, especially, during surgery in this region.

 
  References Top

1.Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of human anatomic variation: Catalog, atlas and world literature. Baltimore: Urban and Schwarzenberg; 1984. p. 83-92.  Back to cited text no. 1
    
2.Notkovich H. Variations of the testicular and ovarian arteries in relation to the renal pedicle. Surg Gynecol Obstet 1956;103:487-95.  Back to cited text no. 2
    
3.Mirapeix RM, Sañudo JR, Ferreira B, Domenech-Mateu JM. A retrocaval right testicular artery passing through a hiatus in a bifid right renal vein. J Anat 1996;189:689-90.  Back to cited text no. 3
    
4.Notkovich H. Testicular artery arching over renal vein: Clinical and pathological considerations with special reference to varicocele. Br J Urol 1955;27:267-71.  Back to cited text no. 4
    
5.Terayama H, Yi SQ, Naito M, Qu N, Hirai S, Kitaoka M, et al. Right gonadal arteries passing dorsally to the inferior vena cava: Embryological hypotheses. Surg Radiol Anat 2008;30:657-61.  Back to cited text no. 5
    
6.Ozan H, Gümüþalan Y, Onderoðlu S, Simþek C. High origin of gonadal arteries associated with other variations. Ann Anat 1995;177:156-60.  Back to cited text no. 6
    
7.Williams PL, Bannister LH, Dyson M, Warwick. Embryology and development - cardiovascular system. In: Gray's Anatomy. 38 th ed., Edinburgh: Churchill Livingstone; 1995. p. 324-6, 1558.  Back to cited text no. 7
    
8.Koc Z, Ulusan S, Oguzkurt L. Right ovarian vein drainage variant: Is there a relationship with pelvic varices? Eur J Radiol 2006;59:465-71.  Back to cited text no. 8
    
9.Satyapal KS, Kalideen JM, Haffejee AA, Singh B, Robbs JV. Left renal vein variations. Surg Radiol Anat 1999;21:77-81.  Back to cited text no. 9
    
10.Warren WD, Salam AA, Faraldo A, Hutson D, Smith RB 3 rd . End renal vein-to-splenic vein shunts for total or selective portal decompression. Surgery 1972;72:995-1006.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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