The thesis is devoted to the study of individual anatomical variability of arteries and veins of the suprarenal gland. Architecture, topography and linear parameters of suprarenal arteries and veins were studied on 90 cadaveric adrenal glands and their surroundings included inferior vena cava, inferior phrenic, hepatic and renal veins. Specimens were subjected to casting by silicone resin according to the original method, formalin fixation, routine dissection. The histological examination and light microscopy of the series of full-thickness adrenal gland slices were performed. Linear parameters, topography and arising points of adrenal arteries and opening points of adrenal veins were investigated. Orifices of suprarenal arteries and veins, their number, type of ramification, position to the capsule, limits and mean of diameter and length were identified. Superior suprarenal artery was identified in all cases and classified into two types of architecture: solitary and supernumerary, that predestines absence of the accessory superior suprarenal artery. Middle suprarenal artery was identified in 41,1% of cases and presented by single or duplicated trunk with all types of ramification. Inferior suprarenal artery was identified in 91,1% of cases and presented by single or duplicated trunk with the biggest average diameter (1,94±0,26 mm). Adrenal venous drainage is performed by the central and peripheral veins and were identified in all cases. Some of them arise at the hilum while other ones penetrated adrenal capsule and arise over its surface. The first one is known as a central vein. Central veins were presented by single or duplicated trunk that opened separately from each other to inferior vena cava (IVC). Anatomy of the central adrenal vein (CAV) is presented on the right. The average length was 11,9±2,16 mm, average diameter was 4,1±0,34 mm. The direction of CAV was ascending. The duplicated trunk was seen in 4 cases that drained separately into IVC. The adrenal hilum was predominantly located on the anterior surface closer to the superior margin. Aberrant drainage of CAV was classified into 2 groups. The first variation was seen in 3 cases that included CAV joined with accessory hepatic vein. The second variation was detected in one case when CAV was inserted into right renal vein.Anatomy of the CAV is presented on the left. The average length was 19,4±3,41 mm, the average diameter was 3,8±0,37 mm. The adrenal hilum was predominantly located on the anterior surface closer to the inferior (renal) margin. The duplicated trunk was seen in 8 cases that drained separately into the left renal vein (LRV). In 32 cases (71,1%) CAV joined with left inferior phrenic vein to form a common adrenal-phrenic trunk that opened into LRV. A number of smaller peripheral adrenal veins (PAV) that were detected over the adrenal surface varied in a wide range (2-9). Peripheral adrenal veins arise at the level between medulla and cortex by the intramural tributaries. The most frequent collector of PAV was the external part (first 7mm) of CAV and were seen in 65 cases (72,2%). PAV that opened to inferior phrenic vein have an incidence 51,1% (3 cases on the right, 43 cases on the left). PAV of the medial sector that opened to IVC were detected just on the right in 39 cases, PAV of inferior sector that drained to the renal vein were detected just on the left side. Diameter of PAV varies from 0,6 to 1,3mm. The variations in CAV architecture were reported in 17,8%. The most frequent architecture of right CAV was presented by the single ascending vein arisen on anterior surface, closer to superior margin. On the left CAV was presented by the single descending vein arisen on anterior surface closer to renal margin and form a common adrenal-phrenic trunk which opened to LRV. Present study shows detailed anatomic classification of the adrenal vasculature. Suprarenal arteries were classified into superior, middle and inferior ones. According to the arising point they were subdivided into main, accessory and aberrant suprarenal arteries; according to the zone of vasculature - precapsular, capsular, cortical and medullary. The number of trunks defines solitary, doubled and supernumerary vessels. We also used a type of ramification as a criterion to classify arteries into monopodial, dichotomous and terminal. The adrenal venous drainage is provided by central and peripheral veins. PAV classified into paraportal, superior, medial and inferior sectors according to their venous collector. CAV variations predict intraoperative bleeding during laparoscopic adrenalectomy and its conversion to open surgery. High incidence of PAV on the left can lead to revival of the adrenal gland after CAV embolization and spontaneous CAV thrombosis. Present thesis reveals morphometry parameters and topography of suprarenal arteries and veins that let to substantiate and plan adrenal sparing surgery and minimally invasive adrenal surgery.
