CLINICAL SIGNIFICANCE OF ANATOMICAL VARIATIONS OF THE RENAL ARTERIES IN DIAGNOSTIC IMAGING AND SURGICAL PRACTICE

Renal arterial anatomy demonstrates considerable interindividual variability, and recognition of these anatomical patterns is essential in diagnostic imaging, kidney transplantation, partial nephrectomy, renovascular surgery, endovascular interventions, and other procedures involving the retroperitoneum. Although the classical anatomical pattern consists of a single renal artery arising from the abdominal aorta and entering the renal hilum, multiple renal arteries, polar arteries, early arterial branching, and unusual arterial origins are frequently encountered. The present study aimed to analyze the principal anatomical variations of the renal arteries and evaluate their clinical importance in modern diagnostic and surgical practice. A narrative literature review was conducted using published anatomical, radiological, and surgical studies focused on renal arterial variations, computed tomography angiography, donor nephrectomy, renal transplantation, and vascular reconstruction. The reviewed evidence demonstrates that accessory or multiple renal arteries are among the most common renal vascular variants and may occur in approximately one fifth to one third of individuals, although prevalence varies according to population and methodology. Computed tomography angiography provides highly accurate preoperative visualization of the renal vasculature and allows identification of the number, origin, course, branching pattern, and renal entry point of renal arteries. Multiple arteries and lower polar arteries are especially relevant during renal transplantation because they may require additional vascular reconstruction and may influence ureteral blood supply. Early arterial branching may also complicate vascular clamping and anastomosis. Therefore, detailed preoperative assessment of renal arterial anatomy is essential for reducing vascular and urological complications and optimizing surgical planning. Anatomical variations of the renal arteries should be regarded as clinically significant vascular patterns rather than rare incidental abnormalities.