EVAR Approach for Abdominal Aortic Aneurysm with Horseshoe Kidney: A Multicenter Experience

Fabiani, Mario Alejandro; González-Urquijo, Mauricio; Riambau, Vicente; Puerta, Carlos Vaquero; Mosquera, Nilo J.; Frolov, Serguey Varona; Maldonado, Thomas S.

doi:10.1016/j.avsg.2018.10.042

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Algumas possibilidades terapêuticas são levantadas para pacientes portadores desse duplo acometimento (AAA e rim em ferradura): tratamento cirúrgico aberto com acesso transperitoneal, tratamento cirúrgico aberto com acesso retroperitoneal ou tratamento endovascular. (Fabiani et al, 2019).…”

Section: Discussionunclassified

Correção endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso e revisão das estratégias terapêuticas

Reis

Santos

Melo

et al. 2022

RSD

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O rim em ferradura é uma das anomalias urológicas congênitas mais comuns e está presente em cerca de 0,12% dos pacientes com aneurisma de aorta abdominal. A causa mais comum é a degeneração da parede pela doença aterosclerótica, e, entre outras causas, incluem-se infecção, necrose cística, artrite, trauma e doenças do tecido conjuntivo. O reparo cirúrgico convencional está associado a dificuldades técnicas que provavelmente aumentam a morbidade e a mortalidade, mas que podem ser evitadas com o tratamento endovascular. A correção do aneurisma de aorta abdominal via endovascular é uma técnica menos invasiva se comparada a técnica aberta convencional, onde é feito um reforço da parede arterial para evitar que o seguimento afetado se rompa. No presente artigo. relatamos um caso de um paciente do sexo masculino de 69 anos com rim em ferradura e aneurisma de aorta abdominal infrarrenal, que foi submetido ao reparo endovascular do aneurisma com sucesso.

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Section: Discussionunclassified

Correção endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso e revisão das estratégias terapêuticas

Reis

Santos

Melo

et al. 2022

RSD

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“…Fabiani et al reported an 81-year-old patient with previous renal failure (creatinine level: 1.8 mg/dL) who required 3 weeks of hemodialysis after EVAR, which occluded two ARAs to the isthmus. 5 ) By using selective angiography of the ARAs with/without a CT scan, the patient’s postoperative renal function can be predicted by calculating the volume of the estimated area of renal isthmus infarction, which is caused by occlusion of the ARAs. However, this angiography is an invasive examination for patients, including the possibility of embolization and vascular injury.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Aneurysm Repair for a Patient with Horseshoe Kidney and the Importance of Watershed Sign and Volumetry by Preoperative Contrast-Enhanced Computed Tomography

Handa

Sakamoto

Kakizawa

et al. 2021

Annals of Vascular Diseases

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We report a case of endovascular aneurysm repair (EVAR) in a patient with horseshoe kidney (HSK) in whom preoperative contrast-enhanced (CE) computed tomography (CT) showed watershed sign. This sign enabled prediction of postoperative renal function by accurate renal volumetry. A 75-year-old man with HSK and a 59-mm abdominal aortic aneurysm was referred for treatment. Preoperative CECT showed watershed lines at the margin of the isthmus, which was perfused by the accessory renal arteries. Using this sign, we calculated the accurate volume of the isthmus, which was 24.5% of the total parenchyma. EVAR was safely performed without renal dysfunction.

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“…It has been known that most type I to type IV Eisendrath classification cases could be managed endovascularly; however, more complex cases, such as type V cases where there are multiple accessory renal arteries, are generally not recommended because of the complex vascular anatomy. 20,21 Nevertheless, some authors have proved that type V can also be managed endovascularly, using chimney o fenestrated techniques. Sharma et al 12 reported a 61-year-old male patient in whom a ChEVAR was successfully performed to preserve the IMA and flow to the HSK.…”

Section: Discussionmentioning

confidence: 99%

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

et al. 2021

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Purpose: A systematic review of all patients that have been reported in the literature with abdominal aortic aneurysm (AAA) concomitant with horseshoe kidney (HSK) treated electively by endovascular aneurysm repair (EVAR) is presented. A new grouping system for describing HSK vasculature is implemented. Materials and Methods: We searched for published manuscripts using the Medical Subject Headings terms “abdominal aortic aneurysm,” “AAA,” “EVAR,” “endovascular aneurysm repair,” and “horseshoe kidney” in PubMed, Google Scholar, Scopus, and National Center for Biotechnology Information databases. Inclusion criteria include all published material of patients with AAA with HSK treated electively by an endovascular approach. We excluded patients who were treated by a hybrid or open repair or patients with ruptured AAA. Statistical analysis was carried out using SPSS Statistics version 25 (IBM Corp, Armonk, New York) software. Results: A total of 50 patients from 30 studies were included for analysis. Males made up 88% (n=44) of the population. The median age for this cohort was 70 years (range: 47–86 years). Median aneurysmal diameter was 6.0 cm (range: 4.0–10.3 cm). The median operative time for endovascular repair was 84 minutes (range: 40–332 minutes). The most common graft used was Zenith, used in 40% (n=20) of the cases, followed by Endurant in 14% (n=7). The overall complication rate was 14% (n=7). The median follow-up was 19 months (range: 1–108 months). While comorbidities did not appear to impact outcomes significantly, median operative times for smokers were higher than those in nonsmokers, 84 versus 118 minutes, respectively (p=0.048). Univariate linear regression modeling of aneurysmal size with age, operative time, and length of stay revealed a significant coefficient association between aneurysmal size and operative times. After adjusting for comorbidities and aneurysmal size, prior history of chronic kidney disease significantly increased odds for renal infarction. Conclusion: This review presents the most complete data set possible of patients with concomitant HSK and AAA treated by an endovascular approach. Furthermore, the A + B + C classification for grouping the HSK vasculature is implemented. This systematic review suggests EVAR to be an excellent option with low complication rates for the treatment of AAA in patients with HSK.

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EVAR Approach for Abdominal Aortic Aneurysm with Horseshoe Kidney: A Multicenter Experience

Cited by 10 publications

References 23 publications

Correção endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso e revisão das estratégias terapêuticas

Correção endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso e revisão das estratégias terapêuticas

Endovascular Aneurysm Repair for a Patient with Horseshoe Kidney and the Importance of Watershed Sign and Volumetry by Preoperative Contrast-Enhanced Computed Tomography

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

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