Anatomy - Percutaneous transluminal angioplasty (PTA) and stenting in bilateral renal artery stenosis - Vascular surgery

Origin

• It is the extension of the thoracic aorta after it passes through the aortic hiatus at the level of 12th thoracic vertebra (T12)

Course

• Retroperitoneal
• Left of midline, anterior to spine
• At the level of umbilicus/4th lumbar vertebra (L4) dividing (aortic bifurcation) into the common iliac arteries

Cephalocaudal branches

• Inferior phrenic arteries
• Celiac trunk
• Left and right middle suprarenal artery
• Superior mesenteric artery
• Left and right renal artery
• Left and right ovarian / testicular artery
• Lumbar arteries
• Inferior mesenteric artery
• Median sacral artery

Arterial blood supply for

• Paired branches: abdominal wall, paired retroperitoneal organs, gonads
• Unpaired branches: spleen, unpaired digestive organs

Arterial supply to the kidney is via the renal arteries originating directly from the aorta. Venous return is via the homonymous renal veins terminating in the inferior vena cava.

After arising from the abdominal aorta the right renal artery crosses posterior to the inferior vena cava, while the left renal artery travels directly to the renal hilum. The reverse is true for the veins: The right renal vein travels directly to the inferior vena cava, whereas the left renal vein crosses anterior to the aorta.

The renal artery divides shortly before the renal hilum into its principal branches. Around 18% of the population have more than one renal artery, 2–3% have even more than three renal arteries.