Surgical Treatment of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney: Symphysiotomy Using Harmonic Focus

Chihara, Shingo; Fujino, Takayuki; Matsuo, H; Hidaka, Atsuhiro

doi:10.5761/atcs.cr.13-00115

Cited by 12 publications

(11 citation statements)

References 7 publications

(11 reference statements)

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“…Also Chihara et al 9) reported a case of AAA associated with HSK, with division of the kidney isthmus by using a Harmonic Focus, recurring to a transperitoneal approach. They reconstructed the renal accessory artery and no postoperative renal disfunction was observed.…”

Section: Discussionmentioning

confidence: 99%

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

Caridi

Massara

Greco

et al. 2015

Annals of Vascular Diseases

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Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required.We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. Keywords: horseshoe kidney, infrarenal abdominal aortic aneurysmIn 90% of cases computerized tomography (CT) gives the most detailed information about the morphology of HSK and the anatomic relationships between the kidney, its blood vessels, and the aneurysm. 2) Here we present our operative strategy to treat a patient affected by a voluminous symptomatic AAA associated with HSK, through a left retroperitoneal surgical approach. Case ReportA 67-year-old man with a history of hypertension, dyslipidemia and diabetes mellitus, reported to the emergency room complaining acute onset of abdominal pain, probably due to a rapid enlargement of the aneurysm diameters. Clinically, a pulsatile abdominal mass was observed. Computed tomography (CT) demonstrated an AAA measuring 6.68 cm × 5.74 cm in diameter, associated with a HSK, with the isthmus lying anterior to the aneurysm, containing functional parenchymal tissue (Fig. 1A). Three main left and one right renal arteries were detected through CT scan. One small accessory renal artery, arising from the aneurismal wall near to the inferior mesenteric artery origin was observed. Also, the presence of one small accessory renal artery arising from the right common iliac artery that presented a diameter of 31 mm and of a large renal accessory artery arising from the left common iliac artery were detected (Fig. 1B). Even if Ruppert and colleagues 3) reported that endovascular aneurysm repair with coiling of the renal accessory arteries can be performed safely in presence of HSK, we did not chose this option for our patient, in order to avoid possible complications, such as occlusion of accessory renal arteries with subsequent renal infarction and the development of type 2 endoleaks, that are reported in literature. 4) The rapid onset of abdominal pain leads us to opt an emergency operation. With the patient in the right semilateral position, we recurred to a left retroperitoneal approach on the retro-renal space, in order to avoid the kidney isthmus resection and urinary tract damage. The renal isthmus containing functional parenchymal tissue

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Section: Discussionmentioning

confidence: 99%

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

Caridi

Massara

Greco

et al. 2015

Annals of Vascular Diseases

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“…There are reports on the preservation of the renal isthmus without complications even when the renal isthmus was cut. 3) On the other hand, as there are concerns about complications such as hemorrhage, urinary extravasation, and infection after resection of the renal isthmus, this technique must be used with caution. 4) By selecting the retroperitoneal approach during open repair, it is possible to approach aneurysms even with the accessory renal artery or ureteral abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Successful Endovascular Repair of an Abdominal Aortic Aneurysm in a Patient with a Horseshoe Kidney and Accessory Renal Arteries Using an Aortic Cuff to Prevent Type II Endoleak

Mikami

Kamada

Uchiyama

et al. 2021

Annals of Vascular Diseases

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A 78-year-old man presented with an abdominal aortic aneurysm (AAA) and a horseshoe kidney coexisting with accessory renal arteries. We performed surgical treatment with endovascular aneurysm repair, sacrificing the accessory renal arteries. We used an aortic cuff to prevent a type II endoleak from the inferior mesenteric and accessory renal arteries. Decreased renal function was transient, and postoperative computed tomography showed no endoleak. This case report supports the feasibility of endovascular surgery for treating AAA in patients with a horseshoe kidney.

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“…As in laparoscopic heminephrectomy of HSK, division may be aided by the use of staplers and energy devices [ 5 ]. Chihara et al [ 6 ] recently reported the use of a harmonic scalpel to divide the isthmus during AAA surgery.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Repair of Abdominal Aortic Aneurysm Coexisting with Horseshoe Kidney

Han

Kim

Choi

et al. 2015

VSI

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Horseshoe kidney (HSK) is the most common congenital abnormality of the urologic system encountered during abdominal aortic aneurysm (AAA) surgery. Here, the authors report a case of AAA coexisting with HSK that was successfully treated by open surgery. Two accessory renal arteries of 2.5 mm and 3.1 mm were reimplanted. One of the implanted arteries later occluded and infarct of the isthmus developed, but there was no impairment of renal function. The authors discuss the complexity of the surgical treatment of AAA coexisting with HSK, and place focus on which accessory renal arteries should be reconstructed.

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Surgical Treatment of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney: Symphysiotomy Using Harmonic Focus

Cited by 12 publications

References 7 publications

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

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

Successful Endovascular Repair of an Abdominal Aortic Aneurysm in a Patient with a Horseshoe Kidney and Accessory Renal Arteries Using an Aortic Cuff to Prevent Type II Endoleak

Open Surgical Repair of Abdominal Aortic Aneurysm Coexisting with Horseshoe Kidney

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