Peculiar arrangement of the renal vein located between two branches of renal artery: Anatomical study with clinical implications

Objective: The classical arrangement of the structures at the hilum are renal vein, renal artery and the renal pelvis (i.e. ureter), from anterior to posterior direction. In routine anatomy teaching, this important relation is being taught to the undergraduate medical students. The anomalous arrangement of the renal vein, artery or the renal pelvis is uncommon and even standard anatomy textbooks do not highlight such facts. The aim of the study was to define the exact relation of the renal vein, artery and the pelvis in dissected cadaveric kidney specimens. Materials and methods: A total of 50 kidneys irrespective of sides were taken for a detailed study of the renal hilar structures. Results: Out of 50 specimens, only one left kidney exhibited anomalous arrangement of the structures at the hilum (2%). The renal artery was located anterior to the renal vein. At a distance of 0.8 cm from the hilum, the renal artery further divided into three accessory branches which entered the hilum. The renal vein was located posterior to the renal artery and was found to traverse a course between the upper two branches of the renal artery. Conclusion: Paucity of reports on the anomalous arrangement of renal hilar structures makes these findings significant. Knowledge of the topographical anatomy of the renal vein, artery and the pelvis at the hilum is important for surgeons performing renal transplants and radiologists interpreting angiograms.