Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 334-337  

Tortuous abdominal aorta with right testicular vein terminating into right renal vein: A report from cadaveric dissection


Department of Anatomy, Padmashree, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India

Date of Web Publication5-Jul-2013

Correspondence Address:
Manvikar P Rao
Department of Anatomy, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune - 411 018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.114678

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  Abstract 

During routine dissection, tortuous abdominal aorta along with tortuous common iliac arteries was noticed in a male cadaver of approximately sixty years of age. There was no dilatation or reduction in vessel wall thickness as is usually seen in aneurysms. Abnormal path of a vessel and more so tortuosity is said to be the result of localized atherosclerosis. Concurrently gonadal vein abnormality was also seen. Normally the right gonadal vein terminates into inferior vena cava, but in this case, it was seen terminating into right renal vein. Anomaly in gonadal vein termination can be explained on embryological basis. Tortuosity of abdominal aorta has bearing on procedures involving catheterization. Arterial manipulation with catheter in such cases needs to be discouraged as blocking of catheter lumen has been reported in angioplasty. Gonadal venous anomaly can be a key factor in successful ligation of vessels for treatment of varicocele. This case is reported with relevance to clinical implication during catheterization and probable indication for pre-procedural imaging study in suspected cases. An unusual association with venous anomaly is unique in this report.

Keywords: Abdominal aorta, aneurysm, catheterization, gonadal vein, renal vein, testicular vein, tortuous


How to cite this article:
Shinde A, Rao MP, Mishra PP, Paranjpe V. Tortuous abdominal aorta with right testicular vein terminating into right renal vein: A report from cadaveric dissection. Med J DY Patil Univ 2013;6:334-7

How to cite this URL:
Shinde A, Rao MP, Mishra PP, Paranjpe V. Tortuous abdominal aorta with right testicular vein terminating into right renal vein: A report from cadaveric dissection. Med J DY Patil Univ [serial online] 2013 [cited 2019 Dec 13];6:334-7. Available from: http://www.mjdrdypu.org/text.asp?2013/6/3/334/114678


  Introduction Top


Abdominal aorta begins at the aortic hiatus of the diaphragm, anterior to lower border of the body of the twelfth thoracic vertebra, descends in front of the vertebral column and ends at the level of fourth lumbar vertebra, commonly a little to the left of the middle line by dividing into the two common iliac arteries. [1] Abnormal localized dilatation with thinning of vessel wall is usually seen in aneurysms. Aneurysmal abdominal aorta, shows thin arterial and usually distorts the anatomy by displacing adjoining structures. We are reporting a case, where the vessel was tortuous and shifted from its usual position. Tortuosity was also noticed in its branches (an unusual finding). Venous anomalies are not unusual. Owing to the complexity of development of inferior vena cava by series of parallel venous channels like posterior cardinal, subcardinal, and supracardinal veins on the posterior abdominal wall on either side of the vertebral column and preferential regression of some segments of these veins, erratic termination of gonadal veins is not a rare entity. In the same cadaver, we also found the right testicular vein anomalously terminating in the right renal vein.


  Case Report Top


During routine dissection, variations in abdominal aorta were seen in a 60-year-old male cadaver. Abdominal aorta was tortuous instead of following a straight course [Figure 1]a. Part of the aorta below the level of origin of renal vessels till its termination at the level of L 5 was curved. The artery was shifted to the right of midline and inferior vena cava was pushed further right [Figure 1]b. The distance of shift from midline was 4.3 cm. Vessel wall of abdominal aorta was normal on palpation. No segmental or localized dilatation was observed [Figure 1]a. In addition, terminal braches and right and left common iliac arteries were also found to be tortuous [Figure 1]a. External iliac arteries on both sides were also found to be wavy.
Figure 1: (a) Tortuous abdominal aorta with wavy common iliac and external iliac arteries. (b) Note the shift of IVC to right

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In addition, venous anomalies were also encountered. Normally right testicular vein terminates in inferior vena cava while on the left side it ends in left renal vein. But in the present case, right testicular vein was seen terminating into the right renal vein. Angle of termination of right testicular vein in right renal vein was approximately right angle, similar to that of left testicular vein. Left testicular vein was normal, and eventually both gonadal veins were seen terminating in renal veins. Right and left renal veins were normal. Arterial anomaly was also observed. An accessory renal vessel, namely, inferior hilar artery, was also seen supplying right kidney [Figure 2] and [Figure 3].
Figure 2: Accessory renal artery supplying right kidney

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Figure 3: Right testicular vein terminating in right renal vein

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  Discussion Top


Arteries generally traverse a designated course and curve with relevance to structures related in the vicinity. Classical examples of tortuous arteries conventionally described and taught to students of anatomy are splenic artery and facial artery. The wavy pattern of these arteries is said to complement the movement of spleen by diaphragm in case of splenic artery. Tortuous facial artery is thought to facilitate mandibular movement in mastication. Course of abdominal aorta and inferior vena cava and their branches or tributaries usually follow a straight course. Tortuous abdominal aorta with wavy common iliac arteries and external iliac arteries arose curiosity.

Winding course of an otherwise straight path, traversing in unusual pattern, is a feature of vascular disease. It is a sign of atherosclerotic changes in the elderly.

Bhatand Muzrakchi [2] stated that tortuous arteries traversing in unusual winding path (meandering) is a feature of vascular disease. These observations are often made during arteriography. In the elderly, these represent signs of atherosclerosis or hypertension. However, tortousity in children may be a sign of underlying systemic disease like  Ehlers-Danlos syndrome More Details or Marfan's syndrome. Course of an artery plays an important role in angiographic procedures like catheterization, and thus evaluation of course of an artery by imaging studies should be part of pre-procedural protocol.

Tortuosity of abdominal aorta is no exception to this, especially when a therapeutic angioplasty or diagnostic angiography is being undertaken, as the catheter reaches coronary ostia after passing through the aorta. Hence, it is necessary to have prior knowledge of the course of abdominal aorta as a catheter has to pass through this aortic segment before reaching the targeted area. In this context, Gerlock Jr and Goncharenko [3] further commented about difficulty in using straight-tipped catheters in patients with tortuous abdominal aorta.

Kara et al. [4] also report an incidence of blocked catheter at the abdominal aorta during coronary angiography. They opined that straight-tipped catheter should be discouraged in catheterization. Probable cause of tortuosity in the present case is likely to be atherosclerosis or early aneurysm of abdominal aorta. However, tortuosity of both common iliac arteries and elderly age of the cadaver point toward atherosclerosis to be a probable etiology.

With reference to venous anomaly, Sofikitis [5] stated that during ligation of testicular veins for treatment of varicocele, the surgeon must explore for any anomalous vessel.

Itoh et al. [6] reported an unusual pattern of venous terminations wherein the right testicular vein drained into the confluence of the right inferior vena cava and the right renal vein. In addition double inferior vena cavae were also seen in the same case. The precise mode of testicular vein formation remains somewhat uncertain. Assala et al. [7] studied 150 cadavers and found variations in the testicular vein in 21.3% of the specimens. Tubbs et al. [8] found unusual lateral divisions of each testicular vein on both right and left sides, which drained into the subcostal veins.

Nayak [9] and Yang [10] have also reported termination of right testicular vein into the right renal vein, which is similar to the finding in the present case. Such variations are said to be due to complicated embryogenesis in this area.

Gonadal veins normally show a pattern of termination, with right terminating in inferior vena cava and left in left renal vein. Termination of left testicular vein in left renal vein at right angle is one of the anatomical causes for varicocele on the left side. In the present case, the right testicular vein seen opening into the right renal vein was similar as on left side. Reason for abnormal venous termination seems to be embryological as discussed below.

Accessory renal arteries are known vascular anomalies. Gurses et al. [11] reported a case of plethora of variation of renal and gonadal arteries in a cadaver. Upper and lower hilar arteries of right kidney arising from abdominal aorta below the origin of inferior mesenteric artery and traversing posterior to inferior vena cava to reach hilum were seen. Left side multiple segmental branches were seen before entering into hilum. Multiple testicular arteries, a superior and an inferior, were seen arising from renal artery apart from aorta. However, there was no tortuosity or testicular vein variations.

In a study of 133 formalin-fixed cadavers, Sampio and Passos [12] reported an incidence of 5.3% of inferior polar artery. It was interesting to note that no associated venous anomalies were reported.

In the present case, unilateral accessory renal artery was seen. It was concluded be an inferior hilar artery.

Findings of tortuosity of a part of abdominal aorta with a gross shift to right, wavy common iliac arteries, with additional gonadal vein anomaly and accessory renal artery make this case a rare presentation.

Embryological Consideration

Development of supracardinal and subcardinal venous channels [13] have been shown in [Figure 4]. It is more likely that an embryological error was the cause for abnormal gonadal venous termination. Testicular veins are said to have common origin from fetal subcardinal vein. [14] The anastomosis between the subcardinal veins forms the left renal vein. When this communication is established, then the left subcardinal vein disappears, while the distal portion remains as gonadal vein. [5] Hence, the right subcardinal becomes the main drainage channel and develops into renal segment of inferior vena cava. So, the right gonadal vein drains into inferior vena cava. Variation of the right gonadal (testicular) vein draining into the right renal vein seems to be because of an anomalous communication between distal portion of subcardinal vein and renal segment of inferior vena cava.
Figure 4: Development of supracardinal and subcardinal venous channels

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Conclusion

Abdominal aorta was found to be tortuous and shifted to right in a 60-year-old male cadaver. Different types of catheterization or intra-aortic balloon pumping commonly done in therapeutic and diagnostic procedures are routed through abdominal aorta. It is likely that a tortuous abdominal aorta, when encountered, can lead to difficulty in negotiation of catheters. Great caution needs to be exercised. Right testicular vein opening abnormally in right renal vein was an additional abnormality. Anomalous vascular malformations play a vital role in pelvic surgeries and more so in steps of renal transplantation. Doppler studies will be of immense value in delineating such malformations.

 
  References Top

1.Borley NR. Posterior Abdominal wall and retroperitoneum. In: Standring S, editor. Gray's Anatomy The anatomical basis of clinical practice. 40 th ed. U.K.: Churchill Livingstone Elsivier; 2008. p. 1069-81.  Back to cited text no. 1
    
2.Bhat V, Muzrakchi AL. Meandering vessels: A sign of arterial tortuosity in plain chest radiography. Heart Views 2008;9:24-6.  Back to cited text no. 2
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3.Gerlock AJ Jr, Goncharenko V. Hazards of straight catheter aortography in the tortuous abdominal aorta. Rev Interam Radiol 1979;4:131-4.  Back to cited text no. 3
    
4.Kara E, Celebi B, Yildiz A, Ozturk N, Uzmansel D. An unusual case of a tortuous abdominal aorta with a common celiacomesenteric trunk: Demonstrated by angiography. Clinics (Sao Paulo) 2011;66:169-71.  Back to cited text no. 4
    
5.Sofikitis N, Dritsas K, Miyagawa I, Koutselinis A. Anatomical characteristics of the left testicular venous system in man. Arch Androl 1993;30:79-85.  Back to cited text no. 5
    
6.Itoh M, Moriyama H, Tokunaga Y, Miyamoto K, Nagata W, Satriotomo I, et al. Embryological consideration of drainage of left testicular vein into the ipsilateral renal vein: Analysis of cases of a double inferior vena cava. Int J Androl 2001;24:142-52.  Back to cited text no. 6
    
7.Asala S, Chaudhary SC, Masumbuko-Kahamba N, Bidmos M. Anatomical variations of human testicular blood vessels. Ann Anat 2001;183:545-9.  Back to cited text no. 7
    
8.Tubbs RS, Salter EG, Oakes WJ. Unusual drainage of the testicular veins. Clin Anat 2005;18:536-9.  Back to cited text no. 8
    
9.Nayak BS. Multiple variations of right renal vessels. Singapore Med J 2008;49:e153-5.  Back to cited text no. 9
    
10.Yang CY, Xue, HG, Tanuma K, Ozawa H. Variations of bilateral testicular veins: Embryological and clinical considerations. Surg Radiol Anat 2008;30:53-5.  Back to cited text no. 10
    
11.Gurses IA, Kale A, Gayretli O, Bayraktar B, Usta A, Kayaalp ME, et al. Biateral variations of renal and testicular arteries. Int J Anat Variat 2009;2:45-7.  Back to cited text no. 11
    
12.Sampioa FJ, Passos MA. Renal arteries: Anatomical study for surgical and radiaological practice. Surg Radiol Anat 1992;14:113-7.  Back to cited text no. 12
    
13.Sadler TW. Langman's Medical Embryology. 10 th ed. New Delhi: Lippincott Williams and Wilkins; 2006. p. 188.  Back to cited text no. 13
    
14.McClure CF, Butler EG. The development of the vena cava inferior in man. Am J Anat 1925;35:331-84.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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