Endovascular and Open Repair of an Abdominal Aortic Aneurysm in Patient with Horseshoe Kidney

Abstract

Horseshoe kidney (HSK) is an uncommon renal complication. The coexistence of abdominal aortic aneurysm (AAA) with HSK is rare. Presence of HSK may be complicated to the anterior approach for the reconstructive surgery of the aorta and iliac vessels, because the isthmus of the HSK lies across the aorta and it has anomalous renal vessels. Technical problems are related to exposure, vascular access, and the preservation of renal tissue. The HSK has a variant arterial supply in the majority of patients with accessory renal arteries arising from the aorta or iliac arteries. The purpose of this report is to describe our experience in the successful treatment of patients who had the coexistence of AAA with HSK. We report two cases of successful reconstruction of the aorta in patients with endovascular repair (EVAR), and open repair without reconstructing accessory renal arteries. Routine spiral CT angiography (CTA) showed the isthmus of HSK and a number of accessory renal arteries and their locations. Since the renal function was normal and the diameter of the accessory renal arteries was smaller than 3 mm, and that of the main renal artery was larger than 5 mm, we planned to repair surgically without reconstructing accessory renal arteries. Postoperatively, renal function remained normal for the long term, and the patients made an uneventful recovery. Their preoperatively careful analysis of the isthmus of HSK and accessory renal arteries can be essential for rational treatment without reconstructing accessory renal arteries of 3 mm or less under normal renal functions.