Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Abdomen
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
In another study (50 dissections), the suprarenal arteries were classified according to the part of the gland they supply. The superior suprarenal arteries supply the superomedial part of the gland, the middle suprarenal supplies the anteromedial part of the gland, and the inferior suprarenal supplies the posterior and the inferolateral aspect of the organ.
In approximately 96% of the 50 cases studied, superior suprarenal arteries arose primarily from the inferior phrenic arteries. In only one case did the supply come from the aorta; in four cases, the superior area of the left suprarenal gland was supplied by both the aorta and inferior phrenic arteries.
The middle suprarenal or capsular arteries usually paired but may be a single vessel. It can originate in any of a number of sites. The right and left middle suprarenal arose from the inferior phrenic in 24 cases, from the renal artery in four cases, and from the celiac trunk in three cases. The middle suprarenal was replaced (on the right or left side) by the superior suprarenal artery in nine cases, and by the inferior suprarenal in 41 cases.
The middle suprarenal sometimes provides a spermatic (testicular) artery, more frequently on the left than on the right side.
In one case, both the inferior suprarenal and the middle suprarenal arteries supplied the anteromedial part of the organ.
The inferior suprarenal arteries are considered to be very important because they supply all or most of the gland. They may be grouped, according to their point of origin from the renal artery, as proximal, middle, or distal. They are often multiple; they are larger and always branch before entering the the organ, unlike the superior suprarenal artery.
The inferior suprarenal artery arose from the renal artery in 46% of the 50 cases. In 30% of cases, the artery arose from the aorta; in 17 cases, both the aorta and renal artery supplied the posterior and inferolateral parts of the suprarenal gland. The gonadal artery also may give rise to the inferior suprarenal artery.
The superior suprarenal arteries can consist of from three to 30 small branches from the inferior phrenic artery. They can also originate as direct branches from the aorta, celiac, or superior renal polar, or from a second inferior phrenic.
The middle suprarenal is usually a single vessel (85% of cases found in one study). It often arises from the aorta, but may also originate from the inferior phrenic, renal, aortic superior renal polar, or from the celiac trunk. The artery may be doubled, in which case the accessory artery may arise from one of the sources mentioned above. If absent, it is replaced by a superior or inferior suprarenal artery.
In 66% of cases, the inferior suprarenal is a single vessel arising from the aorta (above or below the origin of the renal); from the renal (in cases of doubled renal artery from the lower vessel); superior renal polar; a branch of the renal e.g., gonadal, ureteral, or inferior phrenic.
In 23% of cases, the inferior suprarenal is doubled, with one branch arising from the aorta and the second from the renal near the hilus of the kidney or from an aortic superior renal polar or one of its branches.
In 11% of cases, the inferior suprarenal is multiple, its branches arising from sources listed for the single vessel variety given above. In a study of 200 glands, 12% had no inferior suprarenal artery, 75% had one to seven branches, and 13 had eight to 12 arteries. The mean was 2.75 arteries per gland. The inferior suprarenal contributes less than the superior suprarenal, but more than the middle suprarenal arteries, to the total vascularization of the organ.
The anterior superior capsular branch of the renal provides three to 10 small branches to the inferior and lateral areas of the suprarenal gland. These branches may arise separately from the aorta, middle suprarenal, superior or uppermost branch of doubled renals, or inferior phrenic, or from a common trunk from the the gonadal artery. A rare pattern of blood supply is one in which an inferior phrenic (arising from the aorta) supplies almost all the superior, middle, and inferior portions of the suprarenal as well as an aortic renal polar, kidney capsular branch, and gonadal artery.
The middle suprarenal artery may be absent, multiple, or may not even supply the suprarenal gland.
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