Benefits of performing PCN through Brodels line

Aside from decreasing the chance of bleeding, what are the other benefits of performing PCN through Brodels line?

The approach through Brodel’s line also results in a percutaneous nephrostomy catheter exiting through skin near the posterior axillary line.

So the catheter does not kink and the patient is not uncomfortable lying on it when supine.

What is Brodels line?

• The division in anterior and posterior branches of the renal artery implies the existence of an avascular plane, the so call Brodel’s line.
• This longitudinal zone is described along the convex renal border or just posterior to the lateral aspect of the kidney.
• A study was conducted to describe the extension of Brodel’s line with reference to the renal segments.
• 12 kidneys were injected with acrylic resins to obtain vascular corrosions casts that were analyzed also with computed tomography.
• It was observed the presence of a relative avascular plane in all vascular casts, located on the posterior surface, ascribable to the Brodel’s line.
• In 33% of cases the line extended from the apical to the inferior segments, in the 33% of cases it extended from the superior to the inferior segments, in 33% of cases it is limited to the superior and middle segments.
• Since the Brodel’s line corresponds with the plane of the anterior surface of the posterior hilar calyces, the knowledge of its extension is relevant from the surgical point of view: this area permits a relatively safe access route to the pelvicalyceal system for nephrostomy insertion and incision within this plane results in significantly less blood loss than outside this plane.

Avascular plane of Brodel

The avascular plane of Brodel is the section of renal parenchyma between 2/3 anterior and 1/3 posterior kidney on the cross-section that is relatively avascular.

The reason for its relative avascularity is that it represents the plane where the anterior and posterior segmental renal artery branches meet.

It is located just posterior to the lateral convex border of the kidney and permits a relatively safe access route to the pelvicalyceal system for nephrostomy insertion.