Abstract
We report the surgical treatment of an 81-year-old man with abdominal aortic aneurysm with horseshoe kidney. Preoperative 3 dimensional-computed tomography angiography (3D-CTA) revealed normal right and left major renal arteries and one accessory renal artery supplying blood to the right lower pole and renal isthmus, and no arterial branches between the isthmus and the aneurysm. Contrast-enhanced CT revealed the left and right ureters coursing along on either side of the isthmus and the aorta. We made a midline incision to obtain transperitoneal exposure of the isthmus and the aneurysm. The isthmus could be easily dissected from the aneurysm and the aneurysm was successfully treated with a prosthetic graft, without resection of the isthmus or the accessory renal artery. Postoperatively, the patient showed no evidence of renal dysfunction and was discharged after an uneventful course in the hospital. When considering exposure to the aneurysm and reconstruction of the renal arteries, it is very important to identify the number and location of the renal arteries, evaluate the isthmus and determine the position of ureters by preoperative 3D-CTA and contrast-enhanced CT, and if necessary, intravenous pyelogram.
