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Renal Arteries Revisited: Anatomy, Pathologic Entities, and Implications for Endovascular Management

Author

Radiographics. May-Jun 2021;41(3):909-928. doi: 10.1148/rg.2021200162.

Richard D White 1Katherine S Moore 1M Ghali Salahia 1W Rhodri Thomas 1Andrew C Gordon 1Ian M Williams 1Andrew M Wood 1Ian A Zealley 1

Author Information

1 From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.).

Abstract

The renal arteries (RAs) are important vessels that usually arise from the abdominal aorta and supply the kidneys; thus, these arteries play a vital role in physiologic functions such as hemofiltration and blood pressure regulation. An understanding of the basis for embryologic development and the frequently variable anatomy of the RAs is necessary to fully appreciate the range of diseases and the implications for procedural planning. Hemorrhage from an RA is relatively common and is typically traumatic or spontaneous, with the latter form often seen in association with underlying tumors or arteriopathy. Accurate diagnostic evaluation of RA disease due to conditions such as atherosclerosis, fibromuscular dysplasia, vasculitis, aneurysm, arteriovenous shunt, embolic disease, and dissection is dependent on the use of multimodality imaging and is essential for selecting appropriate clinical management, with endovascular therapy having a key role in treatment. Surgical considerations include extra-anatomic renal bypass, which remains an important treatment option even in this era of endovascular therapy, and RA embolization as an adjunct to tumor surgery. A novel area of research interest is the potential role of RA denervation in the management of refractory hypertension.