ENDOVASCULAR REPAIR OF AN ABDOMINAL AORTIC ANEURYSM IN A PATIENT WITH COEXISTENT HORSESHOE KIDNEY

Authors

  • Inês Antunes Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
  • Rui Machado Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar — Universidade do Porto
  • Sérgio Teixeira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • Duarte Rego Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • Vítor Ferreira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • João Gonçalves Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • Gabriela Teixeira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • Carlos Veiga Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • Carlos Pereira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal
  • Rui de Almeida Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar — Universidade do Porto

DOI:

https://doi.org/10.48750/acv.46

Keywords:

Abdominal Aortic Aneurysm, EVAR, Renal malformation, Horseshoe kidney, Endovascular treatment

Abstract

Introduction/Aims: Horseshoe kidney (HSK) is a renal malformation that results from the kidney's fusion in midline. It is an unusual entity that rarely coexists with Abdominal Aortic Aneurysm (AAA). Because of the anatomical characteristics (intimate relationship between kidney and aorta, variability in the renal arteries, veins and collecting systems emergency) conventional surgery can be technically difficult. Endovascular treatment has emerged as a therapeutic alternative in some cases of congenital renal malformations. We report a case of endovascular aneurysm repair (EVAR) in a patient with coexistent AAA and HSK.

Material / Methods: We review a case of a patient with coexistent AAA and HSK treated by EVAR in our institution with description of diagnosis, treatment, outcome and complications.

Results: A 74-year-old man was referred to our center with an assymptomatic AAA. He had medical history of ischemic heart disease, congestive heart failure and smoking. CT angiography revealed an infrarenal AAA, with 57mm diameter and HSK. After studying anatomical features, the patient was proposed for EVAR. Under general anesthesia both femoral arteries were exposed. An Endurant® II endoprosthesis was deployed immediately distal to an accessory renal artery and two iliac extenders were deployed in the left and one in the right side. Control angiography found an image compatible with endoleak type1 so a new dilatation of the proximal colon with Reliant® balloon was performed. In the final control angiography there was still some reflux into the aneurysmal sac which was interpreted as probable endoleak type 2. Postoperatively angioCT revealed endoleak type 1 which led to reintervention with implantation of an aortic extender Endurant®, with good result. In control angioCT there was no evidence of endoleak and all renal arteries were patent.

Conclusions: EVAR has clear advantages in cases of coexistent AAA and HSK, anatomically complex for conventional surgery. Although renal vasculature in these patients is very variable, sometimes with accessory arteries responsible for vascularization of considerable percentages of parenchyma. Thus, preoperative planning is essential to assess the need to exclude accessory renal arteries and consider, individually, the risk / benefit ratio.

Downloads

Download data is not yet available.

References

1. Artioukh DY, Wake PN, Edwards PR, et al. Problems of Abdominal
Aortic Aneurysm Associated with Horseshoe Kidney. Eur J Vasc
Endovasc Surg 1997;;14:75- 78
2. Saadi EK, Dussin LH, Moura L, et al. Endovascular repair of an
abdominal aortic aneurysm in patient with horseshoe kidney: a
case report. Rev Bras Cardiovasc. 2008;;23(3):425- 428
3. Glenn JF. Analysis of 51 patients with horseshoe kidney. N Engl J
Med. 1959; 261:684- 687
4. Tan TW, Farber A, F.A.C.S., et al. Percutaneous Endovascular
Repair of Abdominal Aortic Aneurysm with Coexisting Horseshoe
Kidney: Technical Aspects and Review of the Literature. Int J
Angiol 2011;;20(4):247- 250
5. Cohn LH, Stoney RJ, Wylie EJ. Abdominal aortic aneurysm and
horseshoe kidney. Ann Surg. 1969;;170(5):870- 874
6. Davidovic L, Markovic M, Ilic N, et al. Repair of abdominal aortic
aneurysm in the presence of the horseshoe kidney. Int Angiol.
2011;30(6):534:540
7. Eisendrath DN, Phifer FM, Culver HB. Horseshoe kidney. Ann Surg
1925;;82(5):735-764
8. Silvestre JMS, Schimit GTF, Sardinha WE, et al. Endovascular treatment
of abdominal aortic aneurysm in patient with horseshoe
kidney: a case report. J Vasc Bras. 2013;;12(1):62- 67
9. Ferko A, Krajina A, Jon B, et al. Juxtarenal aortic aneurysm associated
with a horseshoe kidney. Transfemoral endoluminal repair.
Arch Surg 1997;;132(3):316- 317
10. Ruppert V, Umscheid T, Rieger J, et al. Endovascular aneurysm
repair: Treatment of choice for abdominal aortic aneurysm coincident
with horseshoe kidney? Three case reports and review of
literature. J Vasc Surg 2004;;40(2):367- 370
11. Machado R, Silveira D, Almeida P, Almeida R. Hybrid surgery as a
new perspective for treatment of abdominal aortic aneurysm
associated with congenital pelvic kidney. Angiol Cir Vasc. 22. 2015

Published

2018-12-02

How to Cite

1.
Antunes I, Machado R, Teixeira S, Rego D, Ferreira V, Gonçalves J, Teixeira G, Veiga C, Pereira C, de Almeida R. ENDOVASCULAR REPAIR OF AN ABDOMINAL AORTIC ANEURYSM IN A PATIENT WITH COEXISTENT HORSESHOE KIDNEY. Angiol Cir Vasc [Internet]. 2018 Dec. 2 [cited 2024 Mar. 19];14(1):80-4. Available from: https://acvjournal.com/index.php/acv/article/view/46

Issue

Section

Clinical Case