OriginalArticle IndianJournalofAnatomy Volume9Number1,January–March2020 DOI:http://dx.doi.org/10.21088/ija.2320.0022.9120.6 VariationsintheOriginandDrainingPatternofGonadalVessels withtheirSurgicalSignificanceandDevelopmentalCorrelations PreetiSonje1,NeeleshKanasker2,PVatsalaswamy3 Howtocitethisarticle: PreetiSonje,NeeleshKanasker,PVatsalaswamy.VariationsintheOriginandDrainingPatternofGonadalVesselswiththeir SurgicalSignificanceandDevelopmentalCorrelations.IndianJAnat.2020;9(1):39-43. Author’s Affiliation: 1Professor, 2Associate Professor, 3Professor and Director Academics, Department of Anatomy, DrDYPatilMedicalCollege,DYPatilVidyapeeth,Pune,Maharashtra411018,India. CorrespondingAuthor:NeeleshKanasker,AssociateProfessor,DepartmentofAnatomy,DrDYPatilMedicalCollege,DYPatil Vidyapeeth,Pune,Maharashtra411018,India. E-mail:[email protected] Received04.10.2019|Accepted06.12.2019 Abstract Keywords: Abdominal aorta; Inferior vena cava; Gonadalarteries;Gonadalveins. Variations arevery commonlyfoundin different vessels of the body. Gonadal vessels also show Introduction numerousvariationswhichareimportantinsurgeries ofposteriorabdominal wall. Also,these vesselsare closely related to renal vessels, so, variable origins The testicular arteries arise anteriorly from the of these vessels are of utmost importance in renal abdominal aorta inferior to the origin of renal surgeries.Presentstudywasundertakento observe arteries. Then they pass under the parietal thevariationsinthegonadalvessels. peritoneum on psoas major muscle. The right MaterialsandMethods:30cadavers(26 malesand testiculararterypassesinfrontoftheinferiorvena 4females)embalmedin10%formalinwereprocured cavawhilethelefttesticulararterypassesbehind fromtheAnatomyDepartmentof,DYPatilMedical theinferiormesentericvein.Eacharterythenruns College, Pune. So, sixty gonadal vessels were anteriortothegenitofemoralnerve,ureterandthe dissectedforthisstudy.Thevariablelevelsoforigin ofgonadalarteriesfromabdominalaortaaswellas lower part of external iliac artery and enters the variableoriginsofthesamewerenoteddown.Also, deepinguinalringasacontentofspermaticcord, thevariabledrainingpatternofgonadalveinswere passesviatheinguinalcanaltoreachthetestis. noted.Photographsofallthevariationsweretaken. Pampiniform plexus emerge on the posterior Results:Numerous variations inorigin,level and aspect of testis. In inguinal canal pampiniform source of origin of testicular arteries and ovarian plexusfusetoformfourveinswhichtraveltowards arteries were found. Common variation found was abdominal cavity through deep inguinal ring. their origin from accessory renal arteries. Gonadal Withintheabdomentheseveinscoaleaseintotwo veins also showed, variable draining patterns with veins,whichascendoneachsideofthetesticular sometimesduplicationofveins. artery,anteriortoureter,psoasmajorwhilebehind Conclusion: Variant origin and draining pattern theperitoneum.Leftveiniscrossedbythecolicvein of gonadal vessels are important in the surgeries andrightveiniscrossedbytherootofmesentry. of posterior abdominal wall, renal surgeries like Theseveinsjointoformsingletesticularveins,the renal transplant, surgical excision of tumors of posterior abdominal wall, surgeries on abdominal righttesticularveindrainsintoinferiorvenacava aorta etc. Also, these variations are important for atanacuteanglejustinferiortothelevelofrenal radiologistsandalso,forsurgeriesofvaricocoeleand veinswhilethelefttesticularveinopensintotheleft testiculartumors. renalveinatarightangle.Ovarianarteriesarethe ©RedFlowerPublicationPvt.Ltd. 40 PreetiSonje,NeeleshKanasker,PVatsalaswamy/VariationsintheOriginandDraining PatternofGonadalVesselswiththeirSurgicalSignificanceandDevelopmentalCorrelations branchesofabdominalaortaandoriginatesbelow testicularveinwasseeninallthefourcases renal ateries. Each descends behind peritoneum, ofwhichonetesticularveinwasdraining crosses the external iliac artery and vein at the into left renal vein while the other was pelvicbrimtoenterthetruepelvis. draining into circumaortic renal vein, Ovarianplexuspresentinthemesovariumand shows(Fig.1). suspensory ligament give rise to ovarian veins. 2. Accessory renal artery giving rise to They usually merge to form a single vein which accessory testicular artery on left side in drainsintotheinferiorvenacavaontherightside 4cases(Fig.2), while in two cases it was andtherenalveinontheleftside.1 seenbilaterally(Fig.3). Thepurposeofthepresentstudywas toknow 3. Drainageofrighttesticularveinintoright thedifferenttypesofvariationsingonadalvessels. renalveinwasseenin3cases(Fig.4). Thesevariationsareimportantforsurgeonsaswell 4. Level of origin of right testicular artery asforradiologists.Theyareimportantinsurgeries fromabdominalaortawasseenatthelevel of posterior abdominal wall, renal transplant of origin of inferior mesenteric artery in surgeries,surgical excision oftumors ofposterior 2cases(Fig.5). abdominalwall,surgeriesonabdominalaortaetc. 5. Duplication of left ovarian vein with their drainage into left renal vein, while MaterialsandMethods drainage of right ovarian vein was seen into right renal vein (Fig. 6). This was Thirtycadavers(26malesand4females)embalmed foundinsinglecase. in10%formalinwereprocuredfromtheDepartment ofAnatomy,DYPatilMedicalCollege,Pune.So, sixtygonadalvesselsweredissectedforthisstudy. The level of origin of gonadal arteries as well as variations in their origin were noted down. Also, thevariabledrainingpatternofgonadalveinswere noteddownandphotographed. Steps of dissection were followed as per Cunningham’s manual of practical anatomy volume2.2 Thestepsofdissectionwereasfollows: • Allthespecimenwerelabeledwithnumber; • Anterior abdominal wall was already dissected as cadavers were dissected by undergraduatestudents; • Abdominalorganswereremovedtoexpose theposteriorabdominalwall; • Abdominalaortaandinferiorvenacavawere dissectedmeticulouslyandvariantoriginof gonadalarteries,alongwithdrainingpattern ofcorrespondingveinswereobserved; Fig.1:Circumaorticleftrenalveinalongwithduplicationofleft • Allthevariationswerenoteddown; testicularvein.Onetesticularveinwasdrainingintoleftrenal veinwhiletheothertesticular • Photographsofthevariationsweretaken. Abbreviations Results IVC-Inferiorvenacava AA-Abdominalaorta Following variations were noted in the gonadal vessels: LRV-Leftrenalvein CALRV-Circumaorticleftrenalvein. 1. Circumaorticleftrenalveinwasobserved in four cases. Also, duplication of left IndianJournalofAnatomy/Volume9,Number1/January–March2020 PreetiSonje,NeeleshKanasker,PVatsalaswamy/VariationsintheOriginandDraining 41 PatternofGonadalVesselswiththeirSurgicalSignificanceandDevelopmentalCorrelations Abbreviations IVC-Inferiorvenacava RRV-Rightrenalvein RTV-Righttesticularvein Fig.2:Accessoryrenalarterygivingrisetoaccessorytesticular arteryonleftside Fig.5:Righttesticulararteryarisingfromabdominalaortaatthe Abbreviations leveloforiginofinferiormesentericartery ARA-Accessoryrenalartery Abbreviations TA-Testicularartery LTV-Lefttesticularvein IVC-Inferiorvenacava AA-Abdominalaorta LTA-Lefttesticularartery RTA-Righttesticularartery IMA-Inferiormesentericartery Fig.3:Accessoryrenalarterygivingrisetoaccessorytesticular arterybilaterally Fig.6:Leftovarianveinwasduplicatedwasdrainingintoleft renalvein,rightovarianveinwasdrainingintorightrenalvein Abbreviations IVC-Inferiorvenacava AA-Abdominalaorta RRV-Rightrenalvein ROV-Rightovarianvein LRV-Leftrenalvein DLOV-Doubleleftovarianvein. Fig.4:Righttesticularveindrainingintorightrenalvein IndianJournalofAnatomy/Volume9,Number1/January–March2020 42 PreetiSonje,NeeleshKanasker,PVatsalaswamy/VariationsintheOriginandDraining PatternofGonadalVesselswiththeirSurgicalSignificanceandDevelopmentalCorrelations Discussion vein. Becauseofadvancedsurgicaltechniquesforthe Testicular vessels variations are not uncommon. treatment of varicocoele and undescended testis Asperpreviousstudiestesticulararteryvariations theanatomyofgonadalarterieshasassumedgreat aremorecommononrightsideascomparedtoleft importance.Unfamiliaranatomyofgonadalvessels side.Cicekcibaietal.3inhisstudymentioned5.5% duringlaparoscopicsurgeryofabdomenandpelvis ofcasesshowingtheoriginofthegonadalarteries mayleadtovasculartroublesofgonads.11 fromtherenalarteries. Variablearrangementsofrenalandgonadalveins Rusu4andMamathaetal.5observedhighorigin areofimmensesurgicalimportance.Theincidence of testicular artery in their study. Kumar N6 of additional renal vein may contribute to the foundvariationoftesticularveinin21.3%ofcases selection criteria adopted for a donor kidney which were more common on the left side along suitablefortransplantation. with termination of the right testicular vein into Presenceofadditionalrenalveinmayactasan right renal vein and accessory renal vein were alsoobserved. alternate collateral route if the portion of inferior vena cava is interrupted between these veins. Knowledge of the origin and course of the Ithas beenalsoreportedthattherightrenal vein testicular artery is surgically important as its rarely received tributaries, whereas left renal ligature during operative procedures will lead to vein regularly had complex connections with testicular atrophy. So, unusual course and origin other venous channels, which formed the basis ofthetesticulararteryaresurgicallyimportantand of collateral pathways after caval interruption. 7 8 should notbeneglected. SushmaRKotian etal. Asala et al. (2001)12 found 2 cases in which right classied the gonadal vessels according to their gonadal vein was draining into right renal vein, levelandsourceoforigin,asfollows: out