53 © Springer Nature Switzerland AG 2019 Y. Tshomba et al. (eds.), Visceral Vessels and Aortic Repair, https://doi.org/10.1007/978-3-319-94761-7_5 Renal Vascular Anatomic Abnormalities During Open Abdominal Aortic Repair Domenico Baccellieri, Vincenzo Ardita, Gianbattista Tshiombo, Enrico Rinaldi, Yamume Tshomba, and Roberto Chiesa 5.1 Introduction Renal arteries are defned as a pair of lateral branches from the abdominal aorta. Anatomical dissection studies have revealed that in most cases, each kidney receives one renal artery and one renal vein is deputy to drain blood into the inferior vena cava. The left renal vein also receives left suprarenal and left gonadal veins, in addition to the vein coming out from the kidney. Variations in number, source, and course of the renal arteries are common, occurring in 60–80% of reported cases [1, 2]. The renal artery may give rise to branches normally derived from other vessels, such as the inferior phrenic, hepatic, suprarenal, gonadal, pancreatic, and lumbar arteries. The abnormalities in the renal arteries are mainly due to the various developmental posi- tions of the kidney, and the different origin and their variations are explained by the development of mesonephric arteries. During the development in the pelvis, both kidneys are supplied by common iliac artery branches, but later, during migration into the lumbar region, their arterial supply shifts to the abdominal aorta. Extrarenal artery may be classifed into: • Aberrant renal artery • Accessory renal artery Aberrant renal arteries commonly supply the superior or inferior pole of the kidney. Accessory renal arteries are a common vari- ant and are present in ~25% (range 20–30%) of the population. They may originate from the abdominal aorta, either above or below the main renal artery or, on rare occasions, from iliac arteries. D. Baccellieri (*) Unit of Vascular Surgery, San Raffaele Scientifc Institute, Milan, Italy e-mail: baccellieri.domenico@hsr.it V. Ardita · E. Rinaldi Vascular Surgery Unit, IRCCS San Raffaele Scientifc Institute, Milan, Italy G. Tshiombo Vascular Surgeon, Fondazione Cariplo, Milan, Italy Y. Tshomba Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy Unit of Vascular Surgery, San Raffaele Scientifc Institute, Vita-Salute University, Milan, Italy R. Chiesa Unit of Vascular Surgery, San Raffaele Scientifc Institute, Vita-Salute University, Milan, Italy 5 Electronic Supplementary Material The online version of this chapter (doi:10.1007/978-3-319-94761-7_5) con- tains supplementary material, which is available to autho- rized users.