Extraanatomic Renal Revascularization: Surgical and Anatomic Variations

A thoracic-aorta-left renal artery bypass with polytetrafluoroethylene (PTFE) and three gastroduodenal right renal artery bypasses were constructed in four patients in whom loss of renal function and the potential for dialysis were imminent. These extraanatomic bypasses showed durable patency with preservation of renal function. Gastroduodenal- renal bypass requires an appreciation of the anatomic relationship of the right renal artery to the right renal vein. Anatomic studies were performed in 80 human cadavers to assess the anatomic relationships of the right renal artery with respect to the right renal vein. In 50% of the cadavers studied, the right renal artery was superior to the right renal vein. It was located inferior to the right renal vein in 17.5% and directly posterior in 32.5%. Extraanatomic bypasses may be required for treatment of renal hypertension or parenchymal salvage. Gastroduodenal-renal and thoracorenal reconstructions are unusual variants of extraanatomic bypasses, and though uncommonly required, may be extremely useful methods to employ for renal revascularization.