Abstract
The difficulies complications encountered in open surgical repair for infrarenal abdominal aortic aneurysm (AAA) with horseshoe kidney can be avoided by the use of endovascular aneurysm repair. However, the indications for aberrant renal artery reconstruction remain unidentified. A 72-year-old man was referred because of AAA with horseshoe kidney. His renal function was almost normal (cystatin C level: 1.21 mg/l, BUN: 16 mg/dl, creatinine: 0.86 mg/dl). A preoperative abdominal computed tomography (CT) scan revealed an abdominal aortic aneurysm and horseshoe kidney with a substantial isthmus, which was being perfused by an aberrant renal artery from the right common iliac artery. Intraoperatively, selective renal artery angiography showed that less than one third of the total renal mass was being perfused by this aberrant renal artery. We used a Powerlink endovascular graft (Endologix) without reconstruction of the aberrant renal artery. A postoperative enhanced CT scan showed only 17% of the total renal mass to be infaracted. In the present case, we performed endovascular repair without reconstruction of an aberrant renal artery which supplied less than 20% of the total renal mass, without serious deterioration in renal function.
