Aberrant right polar renal artery originating from aortic bifurcation

Introduction Multiple renal arteries are unilateral in approximately 30% of patients and bilateral in approximately 10% [1, 2]. Aberrant arteries usually arise from the aorta or iliac arteries anywhere from the level of T11 to the level of L4. In rare cases, they can arise from the lower thoracic aorta or from lumbar or mesenteric arteries [1]. Aberrant renal artery originating from aortic bifurcation as in our case is an extremely rare variation. It is obligatory to pay attention and keep in mind the possibility of accessory renal vessels during renal transplantations and vascular operations although they may be extremely rare as well as the variation in our case; an aberrant polar renal artery originating from aortic bifurcation. Renal artery variations are common in general population [3, 4]. Frequency of aberrant renal arteries varies between 9% to 76% in anatomic and cadaver studies [3, 5, 6] and it is becoming more important to detect aberrant renal arteries (ARA) due to gradual increase in interventional radiological procedures, urological and vascular operations, and renal transplantation [5–8]. If ARA is missed before these procedures it may lead to multiple complications ranging from hematoma to death. Herein we report a case of aberrant right polar renal artery incidentally found during the evaluation for resistant hypertension. Case Report A fifty-year-old woman suffering from hypertension for 20 years was diagnosed with cerebral aneurysms during the investigation for headaches in 2007. Cerebral aneurysms were treated endovascularly with coil embolization. In 2009 patient was referred to our clinic with relapsing headaches and a new cerebral aneurysm was found but endovascular treatment was postponed due to the malign hypertension reaching levels up to 230/160 mm Hg. Renal artery Doppler ultrasound showed bilateral renal artery stenoses indirectly, according to low resistive index data and the prolongation of acceleration times. Then patient underwent bilateral selective renal arteriography, which showed diffuse extensive atherosclerosis of all arterial vessels, and there was no significant renal artery stenosis. However, there was a single renal artery on the left but double renal arteries on the right. The aberrant renal artery was originating from the terminal aorta at the bifurcation point and supplying the lower pole of the right kidney through the renal capsule (Figure 1a, 1b).