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Utility of 16-MDCT Angiography for Comprehensive Preoperative Vascular Evaluation of Laparoscopic Renal Donors

Steven S. Raman1, Suwalee Pojchamarnwiputh1,2, Kobkun Muangsomboon1,3, Peter G. Schulam4, H. Albin Gritsch4 and David S. K. Lu1

1 Department of Radiology, David Geffen School of Medicine at the University of California at Los Angeles, BL-428 CHS/Box 951721, Los Angeles, CA 90095-1721.
4 Department of Urology, University of California at Los Angeles, Los Angeles, CA.


Figure 1
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  		Fig. 1A —30-year-old woman who underwent left laparoscopic donor nephrectomy. Coronal volume-rendered (VR) image show left aberrant renal venous branch (black arrow) connecting with large gonadal vein (white arrow). Black arrowhead (B) shows left main renal vein. Three right renal arteries are seen in A.

 

Figure 2
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  		Fig. 1B —30-year-old woman who underwent left laparoscopic donor nephrectomy. coronal oblique VR image show left aberrant renal venous branch (black arrow) connecting with large gonadal vein (white arrow). Black arrowhead (B) shows left main renal vein. Three right renal arteries are seen in A.

 

Figure 3
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  		Fig. 1C —30-year-old woman who underwent left laparoscopic donor nephrectomy. Axial oblique volume-rendered image shows large lumbar vein (white arrowhead) connecting with left main renal vein (black arrowhead).

 

Figure 4
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  		Fig. 2A —52-year-old man who underwent left laparoscopic donor nephrectomy. Coronal maximum intensity projection images show a 1-mm accessory renal artery (arrow), which was missed by both reviewers.

 

Figure 5
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  		Fig. 2B —52-year-old man who underwent left laparoscopic donor nephrectomy. axial maximum intensity projection images show a 1-mm accessory renal artery (arrow), which was missed by both reviewers.

 

Figure 6
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  		Fig. 3A —25-year-old man who underwent left laparoscopic donor nephrectomy. Oblique coronal volume-rendered images show small peritoneal artery (arrows) adjacent to renal cortex. Reviewer 2 misinterpreted this vessel as an accessory renal artery (capsular artery).

 

Figure 7
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  		Fig. 3B —25-year-old man who underwent left laparoscopic donor nephrectomy. axial volume-rendered images show small peritoneal artery (arrows) adjacent to renal cortex. Reviewer 2 misinterpreted this vessel as an accessory renal artery (capsular artery).

 

Figure 8
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  		Fig. 4A —38-year-old woman who underwent left laparoscopic donor nephrectomy. Oblique coronal volume-rendered images show single left renal artery with very early branches as two capsular arteries (arrow), but surgical recorded left renal artery and two capsular arteries. Because of limitation of laparoscopic surgical field, surgeons could not dissect medially to identify common origin of capsular arteries, which arose from main left renal artery, 5 mm from aorta.

 

Figure 9
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  		Fig. 4B —38-year-old woman who underwent left laparoscopic donor nephrectomy. Oblique coronal volume-rendered images show single left renal artery with very early branches as two capsular arteries (arrow), but surgical recorded left renal artery and two capsular arteries. Because of limitation of laparoscopic surgical field, surgeons could not dissect medially to identify common origin of capsular arteries, which arose from main left renal artery, 5 mm from aorta.

 

Figure 10
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  		Fig. 5A —Retroaortic renal veins in two patients who underwent left laparoscopic donor nephrectomy. 41-year-old man for whom coronal maximum intensity projection images show small retroaortic renal vein (arrow), which was missed by one reviewer.

 

Figure 11
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  		Fig. 5B —Retroaortic renal veins in two patients who underwent left laparoscopic donor nephrectomy. 41-year-old man for whom coronal maximum intensity projection images show small retroaortic renal vein (arrow), which was missed by one reviewer.

 

Figure 12
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  		Fig. 5C —Retroaortic renal veins in two patients who underwent left laparoscopic donor nephrectomy. 58-year-old woman for whom oblique coronal volume-rendered image shows two retroaortic left renal veins (arrows). One reviewer mischaracterized one of two retroaortic veins as draining lumbar vein.

 

Figure 13
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  		Fig. 6A —61-year-old woman who underwent left laparoscopic donor nephrectomy. Oblique coronal volume-rendered images show small aberrant renal venous branch (white arrows), which connects renal hilar parenchyma with left gonadal vein (black arrow, B). Neither reviewer described this branch.

 

Figure 14
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  		Fig. 6B —61-year-old woman who underwent left laparoscopic donor nephrectomy. Oblique coronal volume-rendered images show small aberrant renal venous branch (white arrows), which connects renal hilar parenchyma with left gonadal vein (black arrow, B). Neither reviewer described this branch.

 

Figure 15
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  		Fig. 7 —54-year-old woman who underwent left laparoscopic donor nephrectomy for whom oblique coronal volume-rendered image shows small venous branch (white arrow), which connects left gonadal vein (black arrow) with inferior renal venous branch (arrowhead). Neither reviewer detected this small accessory vein.

 

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