Abstract
In a 56-year-old man, computed tomography demonstrated a 58 mm aneurysm in the infra-renal abdominal aorta and the hilus of right kidney faced ventrally. There were two right renal arteries: the upper one separated from the abdominal aorta normally, and there was a lower ectopic one from the left common iliac artery. Each of these arteries supplied about a half of the right kidney. At operation, we performed bifurcated graft replacement and an anastomosis of the right lower renal artery to the right limb of the Y graft with continuous blood perfusion to the ectopic renal artery. The right lower renal vein, which ran along the right common iliac artery ventrally, drained into the left common iliac vein and could be preserved. Postoperatively this patient had an uneventful course without renal dysfunction. If renal ischemia is anticipated to be prolonged at operation, selective continuous blood perfusion to ectopic arteries is also useful for renal protection. In a case with a morphological anomaly of a kidney, renal veins as well as renal arteries are occasionally anomalous. Preoperative detailed evaluation by imaging is important to prevent injuring anomalous veins.
