CT-Based Anatomical Mapping of Renal Vascular Variations and it impact on Preoperative Planning in Urological Surgery

Abstract

Objective: To evaluate renal vascular variations using contrast-enhanced CT angiography and determine their role in preoperative planning for urological surgery.

Materials and Methods: A cross-sectional observational study was conducted in the Department of Radiology in collaboration with the Department of Urology at a tertiary care teaching hospital over a six-month period. A total of 200 adult patients undergoing contrast-enhanced multidetector CT angiography for renal evaluation were included using a non-probability consecutive sampling technique. CT images were assessed for renal arterial and venous anatomy, including accessory renal arteries, early arterial branching, multiple renal veins, retroaortic left renal vein, circumaortic left renal vein, and other vascular anomalies. Data were analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Statistical significance was considered at a p-value of <0.05.

Results: The mean age of the participants was 46.8 ± 13.2 years, with 118 (59.0%) males and 82 (41.0%) females. Renal vascular variations were identified in 74 (37.0%) patients. Accessory renal arteries were the most common arterial variation, observed in 48 (24.0%) patients, followed by early arterial branching in 12 (6.0%) and multiple accessory arteries in 4 (2.0%). Normal venous anatomy was present in 168 (84.0%) patients, whereas multiple renal veins, retroaortic left renal vein, circumaortic left renal vein, and late venous confluence were detected in 9.0%, 4.0%, 2.0%, and 1.0% of cases, respectively. CT findings resulted in modification of the anticipated surgical approach in 22.0% of patients and indicated increased operative difficulty in 7.0%. No statistically significant association was found between renal vascular variations and either age (p = 0.611) or gender (p = 0.284).

Conclusion: Contrast-enhanced multidetector CT angiography is a reliable and effective imaging modality for identifying renal vascular variations before urological surgery. CT-based anatomical mapping provides valuable information for individualized surgical planning, facilitates recognition of clinically significant vascular anomalies, and may help reduce operative complications while improving surgical outcomes.