Abstract
Abdominal aortic aneurysm (AAA) associated with horseshoe kidney is rare. The aim of this case series was to report on the reconstruction of accessory renal artery (ARA) in patients who presented with AAA and horseshoe kidney. We enrolled 3 men (mean age 71.7 years) with asymptomatic AAA (mean diameter, 55 mm). The patients displayed anomalous blood supply to the kidney, and AAA with horseshoe kidneys were confirmed in all cases on three-dimensional computed tomography (3D-CT). Patient 1 had an ARA originating from the aneurysm. Patient 2 had 2 ARAs originating from the aneurysm. Patient 3 had an ARA, and the inferior mesenteric artery (IMA) originated from the aneurysm. Division of the renal isthmus and its reimplantation into the aortic graft to preserve the isthmic branch of the ARA were transperitoneally performed. Briefly, ARAs more than 5 mm in diameter were reconstructed using the Carrel patch technique. Renal protection during aortic clamping was not performed in 2 cases, and cold lactated Ringer solution was injected into the ARA in 1 case. In patient 3, the ARA and IMA were simultaneously reconstructed to prevent postoperative ischemic colitis, since the lesion invaded into the internal iliac arteries. All patients successfully underwent prosthetic graft replacement with division of the isthmus of the horseshoe kidney. Postoperative complications related to the separation of the isthmus have not occurred at the time of writing.
(Jpn J Vasc Surg 2010;19:749-755)
