Dissection of an adult male cadaver revealed the presence of an accessory left
testicular artery in addition to the normal right and left testicular arteries. In this
case the accessory left testicular artery originated from the ventrolateral wall of
the descending aorta. The origin was located between the superior mesenteric
artery and the left renal vein. The accessory artery continued to course from the
aorta laterally toward the superior ventral portion of the left kidney and then
passed ventrally to the kidney on its course inferiorly to the pelvic region. Communication
was observed between the accessory left testicular artery and the
left renal artery. This variation of gonadal vasculature is of interest from the
point of view of its embryogenesis, and possible clinical significance

Loukas, M

Stewart, D

English

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Folia Morphol. Vol. 63, No. 3, pp. 355–357Copyright © 2004 Via MedicaISSN 0015–5659www.fm.viamedica.plC A S E  R E P O R T355Address for correspondence: Dr. Marios Loukas MD, PhD, Assistant Professor, Department of Anatomy, American University of theCaribbean, Jordan Road, Cupecoy, Lowlands, Sint Maarten, Netherlands Antilles, tel: 0599 545 2298 ext. 224, fax: 0599 545 2440,e-mail: edsg2000@yahoo.comA case of an accessory testicular arteryMarios Loukas1, 2, Doug Stewart11Department of Anatomy, American University of the Caribbean, Sint Maarten, Netherlands Antilles2Harvard Medical School, Boston, MA, USA[Received 6 April 2004; Accepted 30 April 2004]Dissection of an adult male cadaver revealed the presence of an accessory lefttesticular artery in addition to the normal right and left testicular arteries. In thiscase the accessory left testicular artery originated from the ventrolateral wall ofthe descending aorta. The origin was located between the superior mesentericartery and the left renal vein. The accessory artery continued to course from theaorta laterally toward the superior ventral portion of the left kidney and thenpassed ventrally to the kidney on its course inferiorly to the pelvic region. Com-munication was observed between the accessory left testicular artery and theleft renal artery. This variation of gonadal vasculature is of interest from thepoint of view of its embryogenesis, and possible clinical significance.Key words: left testicular artery, left accessory testicular artery,testicular arterial vasculature, renal arteryINTRODUCTIONThe testicular artery usually arises from the ante-rolateral aspect of the abdominal aorta at the levelof the second lumbar vertebra, 2.5 to 5 cm caudalto the renal artery [4]. It may originate from the re-nal artery or as a branch from a suprarenal or lum-bar artery [2]. The testicular artery courses obliquelydownwards and laterally behind the peritoneum intothe pelvic cavity. During its decent into the pelvic cav-ity, it does not normally give off any branches [7].According to Williams et al. [11], the lateralsplanchnic arteries, which are branches of the dor-sal aorta at the embryonic stage, persist bilaterallyas one testicular and 3 suprarenal arteries. These find-ings are obviously indicative of different develop-mental patterns of origin, course and branching.Certain vascular and developmental anomalies of thekidneys can be associated with variations in thecourse of the gonadal arteries [6, 9]. These anoma-lies can be explained by the embryological develop-ment of both of these organs from the intermediatemesoderm of the mesonephric crest and the vascu-larisation of both the kidneys and the gonads fromthe lateral mesonephric branches of the dorsal aor-ta [1, 3, 5].There have been many reports of accessory tes-ticular arteries [10], bilateral accessory renal and tes-ticular arteries [3], doubling of renal and testiculararteries [2] and variations in the origin of testicularvasculature [10]. However, we present here a caseof an accessory renal artery that, to the best of ourknowledge, has not previously been reported in theliterature. To the clinician any unusual course or lo-cation of the testicular artery may be of importancein pursuing a course of specific surgical proceduresor in diagnostic pathology associated with testicu-lar anatomy.CASE REPORTDuring routine dissection of the abdominal re-gion of a male adult Caucasian cadaver during theHuman Body Course at Harvard Medical School, an356Folia Morphol., 2004, Vol. 63, No. 3accessory left testicular artery was observed (Fig. 1).In this case the accessory left testicular artery origi-nated from the ventrolateral wall of the descendingaorta. The origin was located approximately 2 cminferior to the superior mesenteric artery and 1 cmsuperior to the left renal vein. The accessory arterycontinued laterally from the aorta toward the supe-rior ventral portion of the left kidney and then passedventral to the kidney inferiorly toward the pelvic re-gion. Communication was observed between theaccessory left testicular artery and the left renal ar-tery. In all other respects regional vasculature in thecadaver appeared anatomically normal. The left re-nal vein passed anterior to the descending aorta toreach the left anatomically typical kidney. The rightand left testicular arteries originated from the de-scending aorta, superior to the inferior mesentericartery, with the origin of the left testicular arterypositioned slightly cranial to that of the right testic-ular artery.DISCUSSIONCases have been reported previously of accesso-ry testicular arteries, bilateral accessory renal andtesticular arteries, doubling of renal and testiculararteries and variations in the origin of testicular vas-culature. This is the first documented case of a sin-gular accessory left testicular artery originating fromthe descending aorta between the superior mesen-teric artery and the left renal artery and vein. Specif-ic variations, including a high origin of the gonadalarteries, have been reported in several cases [2, 4,7, 8]. Shinohara et al. [10] reported the most highlypositioned testicular artery ever documented. Ina Japanese male the left testicular artery originatedfrom the aorta 1 cm cranial to the origin of the leftinferior phrenic artery. The high origin of the acces-sory artery in the present case is unique in that itoccurred along with normal testicular arteries andcommunicated with the ipsilateral renal artery.The structures that arise from the region encom-passing the mesonephros, reproductive gland andthe metanephros and suprarenal glands are suppliedby lateral mesonephric arteries arising from the dor-sal aorta [1]. The 9 pairs of the lateral mesonephricarteries are divided into 3 groups as follows: the cra-nial group, consisting of the 1st and 2nd arteries lo-cated cranial to the coeliac trunk that run dorsal toFigure 1. An accessory left testicular artery is revealed arising at the inferior left edge below the superior mesenteric artery and abovethe left renal vein. SMA — superior mesenteric artery, IMA — inferior mesenteric artery, IVC — inferior vena cava.357Marios Loukas et al., Testicular arterythe suprarenal body; the middle group, consistingof 3rd–5th arteries passing through the suprarenalbody, and the caudal group consisting of the 6th–9tharteries passing over the ventral side of the suprare-nal body and forming the rete arteriosus urogeni-tale [5]. Felix reported that although one of the9 arteries develops into the testicular artery, it usuallystems from the rete arteriosus urogenitale [5]. Healso stated that if the testicular artery is derived fromthe cranial group, it will pass dorsal to the renal ar-tery, which is derived from the middle group [5]. Inthe present case, the accessory testicular artery orig-inated dorsal to the renal artery. It is therefore be-lieved to have been derived from the cranial group.Ozan et al. [8] reported two cases of gonadalarteries, together with accessory renal arteries, thatoriginated from the abdominal aorta at a higherlevel. It is notable with reference to our case thatthe left testicular artery branched off from the ab-dominal aorta 5 mm inferior to the origin of thesuperior mesenteric artery and ran laterally ante-rior to the renal artery and vein. The continuationof the artery was normal. Our case was similar re-garding the origin of the left testicular artery. How-ever, it revealed not only a high origin of the ar-tery, but also an unusual course anterior to thekidney, in addition to the fact that it was an ac-cessory vessel.In a study carried out by Onderoglu et al. [7] ona 58-year-old male cadaver, the right testicular ar-tery originated from the anterior aspect of the ab-dominal aorta at nearly the same level as the renalartery. In the cadaver in our present case there wasagain similar variation in the origin of the testicularartery but significant differences involving the ac-cessory vasculature.This variation in our case is important, not onlyfrom a developmental standpoint, but also froma physiological perspective. Accessory arterial vascu-lature and an unusual origin and path of the testic-ular artery is worth reporting in efforts to educateclinicians involved in abdominal and urogenital sur-gical procedures.REFERENCES1. Arey LB (1971) Developmental Anatomy, 6th Ed. WBSaunders Co, Philadelphia, pp. 371–374.2. Bergman RA, Cassell MD, Sahinoglu K, Heidger PM(1992) Human doubled renal and testicular arteries.Ann Anat, 174: 313–315.3. Bremer JL (1915) The origin of the renal artery in mam-mals and its anomalies. Am J Anat, 18: 179-200.4. Brohi RA, Sargon MF, Yener N (2001) High origin andunusual suprarenal branch of a testicular artery. SurgRadiol Anat, 23: 207–208.5. Felix W (1912) Mesonephric arteries (aa.mesonephricae).In: Keibel F, Mall FP (eds.). Manual of human embryo-logy. Vol. 2. J.B. Lippincott, Philadelphia, London, pp.820–825.6. Merklin RJ, Michels NA (1958) The variant renal and su-prarenal blood supply with data on the inferior phrenic,ureteral and gonadal arteries. J Int Coll Surg, 29: 41–76.7. Onderoglu S, Yuksel M, Arik Z (1993) Unusual branch-ing and course of the testicular artery. Anat Anz, 175:541–544.8. Ozan H, Gumusalan Y, Onderoglu S, Simsek C (1995)High origin of gonadal arteries associated with othervariations. Anat Anz, 177: 156–160.9. Rahman HA, Dong K, Yamadori T (1993) Unique courseof the ovarian artery associated with other variations.J Anat, 182: 287-290.10. Shinhara H, Nakatani T, Yoshifumi F, Morisawa S,Matsuda T (1990) Case with a high-positioned originof the testicular artery. Anat Rec, 226: 264–266.11. Williams PL, Warwick R, Dyson M, Bannister LH (1989)Gray's anatomy. 37th Ed. Churchill Livingstone, Edin-burgh, pp. 773–776.

A case of an accessory testicular artery

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A case of an accessory testicular artery

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