Abstract:
Introduction: Abdominal aortic kinking syndrome is a rare congenital malformation characterized by
angulation of the abdominal aorta (AA), which, depending on the degree of inflection, can alter the
origin and trajectory of its branches, including the renal arteries, causing blood flow disorders. The
diagnosis of abdominal aortic kinking syndrome is based on imaging studies that provide accurate data
on the morphofunctional appearance of the aorta and its branches. Purpose: Case presentation of
abdominal aortic kinking syndrome involving the renal arteries.
Materials and methods: A 45-year-old patient diagnosed with arterial hypertension underwent
abdominal aortic angiography at CDM ScanExpert, Chisinau, Republic of Moldova, to determine the
cause, which revealed kinking syndrome.
Results: On the imaging sequences obtained following AA CT angiography, two curves of the
abdominal segment of the aorta were identified: the first located at the middle of the L3 vertebra; the
second at the AA bifurcation (upper edge of the L5 vertebra). At the same time, bilateral accessory
renal arteries were identified. The origin of the left renal artery (LRA) was determined at the middle
of L2, and that of the accessory LRA (originating from the AA) at the lower edge of L2. This
supernumerary artery crossed the LRA in an ascending trajectory and entered the renal parenchyma of
the upper pole. The right renal artery (RRA), originating from the AA at the lower edge of L2, had a
sinuous ascending trajectory caused by the first curvature of the AA, thus corresponding to the lower
edge of L1 at the renal hilum. The accessory ARD started from the AA slightly below the main renal
artery, described a trajectory parallel to it, and penetrated the kidney in the same way through the hilum.
Morphometric: the length of the ARS was 39 mm, the diameter was 5 mm; the length of the accessory
ARS was 65 mm, diameter – 2.6 mm; the length of the ARD was 25 mm (due to the convexity of the
aorta), its diameter – 4 mm; the length of the accessory ARD was 33 mm and its diameter – 3 mm.
Conclusions: One of the causes of hypertension may be angulation of the abdominal aorta, sinuous
course of the renal arteries, presence of accessory renal arteries that intersect and compress the main
renal arteries. Imaging methods such as Doppler sonography and CT angiography are considered the
"gold standard" in identifying kinking syndrome.
