Fenestrated endovascular aneurysm repair with concomitant horseshoe kidney

Abstract

Horseshoe kidney (HSK) is a rare anatomic anomaly that poses surgical challenges in the setting of abdominal aortic aneurysm repair. An endovascular approach is safer for patients yet carries technical challenge because of variable renal vasculature. We present the case of a patient with an infrarenal abdominal aortic aneurysm and concomitant HSK who underwent successful repair with a custom fenestrated endograft with preservation of a midaortic renal artery. Complex endovascular aneurysm repair options for HSK include chimneys and fenestrated stent grafts. We suggest that the availability of custom fenestrated grafts and ongoing skill enhancement among vascular surgeons may make this approach more favorable. (J Vasc Surg Cases and Innovative Techniques 2020;6:14-7.)

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

“…Each graft had a single custom fenestration, which preserved 3 major vessels with no change in renal function. Peters et al 5 used the same technique for the preservation of a mid aortic renal artery.…”

“…Endovascular aneurysm repair (EVAR) may be safer; nevertheless, it carries unique technical challenges related to the fusion kidney parenchyma, along with its renal artery arrangements. 5 Stroosma et al, 6 2 decades ago, reviewed 176 cases of AAA with coexisting HSK. They described 6 different operative techniques: transperitoneal approach with or without separation of the renal isthmus, retroperitoneal approach, placement of a stent-graft, aneurysmal wrap, and exploration without exclusion of the aneurysm.…”

“…Endovascular aneurysm repair (EVAR) may be safer; nevertheless, it carries unique technical challenges related to the fusion kidney parenchyma, along with its renal artery arrangements. 5…”