2018 Volume 27 Issue 4 Pages 259-262
If the accessory renal arteries are large, making a sacrifice of them and prevention type II endoleaks from them during endovascular aneurysm repair (EVAR) is a point of controversy. A 75-year-old woman with horseshoe kidney (HSK) was referred for treatment of a 58 mm infrarenal abdominal aortic aneurysm (AAA). The HSK had an accessory renal artery (ARA) connecting isthmus. The ARA originating from aneurysm neck was 5.5 mm in a diameter. Preoperative estimated glomerular filtration rate (eGRF) was 57 mL/min. EVAR without reconstruction of the ARA was done. We selectively embolized the ARA and covered its ostium with aortic cuff, modified kilt technique, before main body deployment in order to prevent type II endoleaks. There were no endoleaks from the ARA and the HSK remained well perfused, with the infarcted segment of the isthmus only. The eGFR on day 2, two weeks, two months and six months were 44, 46, 49, 49 mL/min, respectively. EVAR without reconstruction of the large ARA and prevention type II endoleaks form it was successfully performed for AAA in a patient with HSK.
