eISSN 1308-4038 International Journal of Anatomical Variations (2010) 3: 132–133 Case Report

Variant course of left gonadal artery

Published online August 19th, 2010 © http://www.ijav.org Mamatha Y ABSTRACT Prakash BS The variations of the arteries that develop from the mesonephric arteries, including renal, gonadal and suprarenal Padma Latha K arteries are common. Variations in the anatomical relationship of the gonadal arteries to the renal vessels are Ramesh BR frequently reported. We here present a case of an unusual origin and course of a left testicular artery arching over left renal vein. The arching of the left testicular artery over the left renal vein could be a possible cause of the left renal vein compression. Therefore, knowledge of the possible existence of arching gonadal vessels in relation to the renal vein could be of paramount importance to vascular surgeons and urologists during surgery Department of Anatomy, Dr. B.R. Ambedkar Medical College, K G Halli, Bengaluru, in the retroperitoneal region. © IJAV. 2010; 3: 132–133. Karnataka, INDIA.

Dr. Mamatha Y, MD Assistant Professor of Anatomy Dr. B.R. Ambedkar Medical College Bengaluru, Karnataka, INDIA. +91 944 8669850 [email protected]

Received December 3rd, 2009; accepted July 10th, 2010 Key words [testicular artery] [variations] [abberrant gonadal artery] [varicocoele] [arched gonadal artery]

Introduction over left renal vein and coursed downwards and laterally The testicular arteries are paired vessels that usually and supplied testis (Figures 1, 2). arise from the abdominal aorta at the second lumbar Discussion vertebral level. Each artery passes obliquely downwards Variations in the origin, course and branches of the and posterior to the peritoneum. Descending on the testicular artery are attributed to their embryonic posterior abdominal wall, each reaches the deep inguinal origin. Accordingly, the embryo has three sets of lateral ring where it enters the spermatic cord [1]. However, mesonephric arteries namely cranial, middle and caudal. they may also originate from the renal artery, middle Usually caudal persists and differentiates into the definite suprarenal artery, and lumbar arteries. They may arise gonadal artery. However, cranial lateral mesonephric from a common stem, may be double, triple or quadruple arteries persist and result in a high origin of the gonadal [2]. artery [5]. Common variations encountered in relation to testicular The gonadal arteries are formed by persistant branches vessels are as follows: level of origin, accessory or aberrant of mesonephric arteries that develop cranial and caudal gonadal artery and unusual course of the artery like to the renal pedicle. If the kidney ascends much higher arching anterior to renal vein and retroperitoneal course carrying its renal vein to a higher level than the origin of [3]. The awareness of these variations is of particular gonadal artery, they become type-III i.e., lower origin of interest in developmental biology and surgical anatomy. the gonadal artery than the renal vein and arches around Moreover, such variations could result in compression renal vein. The type-III is also called the arched testicular of the vessels causing testicular and pelvic varicocele, artery (of Luschka). The frequency of type-III has been hypertension, proteinuria and albuminuria [4]. reported as 6%. Since left kidney ascends higher with Case Report its renal vein than right side the variations incidence is An abnormal course of the left testicular artery was more common on left side [6]. The present case reported uncovered during routine dissection of the posterior is similar to the type-III, as testicular artery was caudal abdominal wall in a 55-year-old male cadaver allotted and posterior to the left renal vein and then arched around for first year undergraduates. The left testicular artery renal vein. arose from the anterior part of the abdominal aorta at the In a preliminary study conducted among Nigerians, the level of origin of renal artery, posterior to renal vein on incidence of variant gonadal arteries reported as 52%. the same side. Then artery ascended upwards and arched The main type of variant was type-III and was found Variant course of left gonadal artery 133

testicular artery in the South Indian population, variant testicular arteries are reported as 14.7%. Among three 1 cases, high origin of the testicular artery as high as the renal artery origin and arching over the ipsilateral renal 2 vein was reported [8]. Compression of the left renal vein between the aorta and 5 3 superior mesenteric artery has been termed as nutcracker syndrome. Obstruction of left renal vein outflow results 4 in venous hypertension [9]. From anatomical point of 6 view the left renal vein compression, because of arched gonadal artery may be considered as cofactor for left renal vein hypertension [6]. Knowledge of possible existence of arching of gonadal vessels in relation to the renal Figure 1. Left testicular artery curving round left renal vein. (1: vein could be of paramount importance to the vascular testicular artery; 2: left renal vein; 3: left kidney; 4: abdominal aorta; 5: inferior vena cava; 6: left gonadal vein) surgeons, urolologists and radiologists during surgery and interventional procedures in the retroperitoneal region [10].

2 References

1 [1] Hollinshead WH. Anatomy for surgeons. Vol. 2. New York, Harper and Row. 1971; 579–580. [2] Bergman RA, Thompson SA, Afifi AK. Compendium of human anatomic variation: Text, atlas and world 5 1 literature. Munich, Urban and Schwarzenberg. 1988; 83. 7 3 [3] Cicekcibasi AE, Salbacak A, Seker M, Ziylan T, Buyukmumcu M, Uysal II. The origin of gonadal arteries in human fetuses: anatomic variations. Ann Anat. 2002; 184: 275–279. 4 [4] Adebisi SS, Singh SP. Anomalous gonadal arteries in relation to the renal vein: A preliminary study in 6 Nigerians. Nigerian J Surg Res. 2000; 2: 148–151. [5] Felix W. Mesonephric arteries (aa. mesonephrica). In: Keibel F, Mall FP, eds. Manual of Human Embryology. Vol. 2. Philadelphia, Lippincott. 1912; 820–825. Figure 2. Left Testicular artery arising from abdominal aorta curving [6] Notkovich H. Variations of the testicular and ovarian arteries in relation to the renal pedicle. Surg round left renal vein. (1: testicular artery; 2: left renal vein; 3: left Gynecol Obstet. 1956; 103: 487–495. kidney; 4: abdominal aorta; 5: inferior vena cava; 6: left gonadal [7] Grine FE, Kramer B. Arched gonadal arteries in the South African Negro. J Anat. 1981; 132: vein; 7: left renal artery) 387–390. [8] Pai MM, Vadgaonkar R, Rai R, Nayak SR, Jiji PJ, Ranade A, Prabhu LV, Madhyastha S. A cadaveric study of the testicular artery in the South Indian population. Singapore Med. J. 2008; 49: 551–555. more among males compared to females [4]. In another [9] Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left study, it is concluded that the frequency of arched renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006; testicular artery was higher on the right side than the 20: 120–129. left among South African Negros (incidences are 22% [10] Ranade AV, Rai R, Prahbu LV, Mangala K, Nayak SR. Arched left gonadal artery over the left renal vein and 2%, respectively) [7]. In a cadaveric study of the associated with double left renal artery. Singapore Med J. 2007; 48: 332–334.