Precaval Right Renal Artery – A Path Less Traveled

Introduction: A Thorough understanding of normal and variant anatomy of the kidneys and renal and retroperitoneal vasculature is most essential for the successful outcome of laparoscopic, robotic, urological, oncogynecological, endovascular, and other interventional procedures. One of the important factors that affects the selection of a renal donor is the presence of multiple renal vessels. Nearly one-third of the population exhibits the presence of supernumerary or accessory renal arteries, and inadvertent damage to such an artery results in segmental renal infarction. Aim: Although a lot of attention was paid to analyze the prevalence of accessory right and left renal arteries, scant attention has been given to the study of a surgically important variant of “precaval” right renal artery (RRA) passing anterior to the inferior vena cava. The present study aims to analyze the prevalence of the precaval RRA (PRRA). Study Design: The present retrospective study was designed to analyze multidetector computed tomographic scans of 732 subjects for the presence of PRRAs and any other associated renal anomalies. Results: The present study detected 37 PRRAs in 34 cases with an incidence of 4.64%. One PRRA was seen in 32 subjects, two in one and three in one case. More commonly, the right inferior polar arteries had a precaval course, and no gender difference was noted. The presence of associated anomalies such as horseshoe kidney, crossed renal ectopia, duplicated pelvicalyceal system, and congenital anomalies of the left renal vein was observed. Conclusion: Preoperative contrast-enhanced computed tomography clearly depicts PRRAs and provides a road map for the successful accomplishment of retroperitoneal surgeries.