Simultaneous Occurrence of Two Renal Artery Variations in a Single Potential Kidney Donor.

Background: Renal transplantation success depends on precise preoperative vascular mapping. This case report documents a rare instance of simultaneous dual renal artery variations in a prospective kidney donor. Procedure: A healthy 27-year-old male underwent MDCT renal angiography following standard protocols. The patient fasted for 8 h, received 80 mL of iohexol contrast at 1 mL/kg via a 20-gauge cannula, and was imaged using a 32-slice CT scanner. Scanning was performed from the descending aorta (just above the celiac trunk) to the iliac bifurcation using bolus tracking for optimal arterial enhancement. CT Findings: The CT scan demonstrated complex renal vascular anatomy. The right kidney was supplied by a main renal artery along with two accessory arteries, one originating laterally at L1 and another from the anterior aortic wall at L2. The left kidney exhibited a main renal artery with a single accessory branch arising immediately above its origin. Discussion: The embryological persistence of multiple aortic branches underlies these variations. Recognition of such anomalies is crucial as they may complicate donor nephrectomy through increased risk of intraoperative bleeding, complex vascular reconstructions, and compromised graft perfusion. Implications and Recommendations: Routine use of high-resolution MDCT angiography is recommended for comprehensive donor evaluation. Enhanced interdisciplinary collaboration between radiologists and transplant surgeons is essential for tailoring surgical approaches and ensuring optimal outcomes. Conclusion: Detailed preoperative imaging is vital for identifying rare renal vascular anomalies, thereby optimizing surgical planning and promoting donor safety.