Abdominal Aortic Aneurysm with Coexistent Horseshoe Kidney

Abstract

Surgical repair of an abdominal aortic aneurysm (AAA) concomitant with a horseshoe kidney (HSK) may be technically demanding because of the complex anomalies of the kidney and of its collecting system and arteries, the greater risk of HSK-related complications, and the often unexpected intraoperative finding of HSK itself. We reviewed a database of more than 500 patients with AAA observed in our surgical department from 1994 to the time of writing. Five patients had AAA concomitant with HSK. Two of these patients did not undergo surgery because of the small dimension of the aneurysm or because of their poor health. The other three underwent successful repair of AAA with different techniques; namely, an aortobifemoral bypass via a thoracoabdominal retroperitoneal incision in one, a straight graft via an emergency median laparotomy in one, and an endovascular repair followed by open surgery 4 years later for endotension in one. Abnormal minor renal arteries were deliberately occluded and only one of these caused a minor renal infarct, but without functional impairment. These data and a review of the literature indicate that HSK should not preclude repair of coexistent AAA, as imaging procedures provide the information necessary to plan the best approach for each patient. Up-to-date surgical procedures, a posteriori retroperitoneal approach or endovascular repair, and deliberate occlusion of the minor renal arteries appear feasible and safe as they avoid most of the anatomical problems and provide results equivalent to those of uncomplicated aortic surgery.

Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

“…1) Despite this relatively high incidence, HSK occurring at same time with AAA is rare occurring in 0.12% of patients affected by AAA. 5) The right retroperitoneal approach to the AAA is also possible, through a parietal-cholic incision, and, if necessary, the Kocher maneuver can be performed when the AAA is very close to the kidney. 7) Through the transperitoneal approach the surgeon could explore the peritoneal cavity, with an optimal exposure of the aorta and both iliac common arteries, of the HSK and both ureters; however, the isolation and preparation of the aneurysmal wall for all its length could be difficult, due to the presence of the renal isthmus.…”

Endovascular repair of an abdominal aortic aneurysm in the presence of a hydronephrotic horseshoe kidney

“…4,5 In the case of EVAR, where accessory renal arteries need to be covered by the stent graft with no option for reimplantation, there is general consensus regarding which of these can be sacrificed without sequela. Accessory arteries of ≤3 mm may be covered, usually without significant sequel, as long as the main renal vascular anatomy can be preserved and the patient has otherwise normal renal function.…”

Abdominal aortic aneurysm surgery for octogenarians

“…Although AAAs with a high risk of rupture should be repaired, there is no point in subjecting a patient to this major operation for an AAA that is unlikely to rupture. [1][2][3] The operative mortality associated with elective AAA surgery has declined remarkably in recent years, and it is now considered a relatively safe operation; however, its indications for patients of advanced age remain unclear. 4,5 To investigate the indications of AAA surgery for octogenarians, we analyzed the results of surgery, postoperative surveillance, and quality of life (QOL), and reviewed the results of patients treated nonoperatively.…”