A Novel Approach to the Management of an Inflammatory Abdominal Aortic Aneurysm Associated With Crossed-Fused Renal Ectopia

Endovascular Repair of an Inflammatory Abdominal Aortic Aneurysm Combined with a Congenital Pelvic Kidney: Case Report and Literature Review

The coexistence of an abdominal aortic aneurysm and a congenital pelvic kidney is extremely rare. We present a 66-year-old male with an inflammatory aneurysm and an aberrant origin of the superior mesenteric artery. The inflammatory infrarenal abdominal aortic aneurysm with a congenital left pelvic kidney was successfully treated with endovascular repair. Coverage of one out of the two renal ectopic arteries was performed, without clinical evidence of renal function impairment.

Lessons for the clinical nephrologist: a rare case of unfused renal ectopia

Right crossed inferior unfused renal ectopia is a rare developmental anomaly in which both kidneys are located on the left side of the body. It's the result of a halt in migration of kidneys to their normal location during the embryonic period and in ureteral bud faulty that migrates to the opposite side and induces the metanephric blastema on the wrong side. In this article, we aim to review embryology and complete description of renal ectopia anatomy and describe a rare case of right crossed unfused inferior renal ectopia with a left lower kidney artery originated directly from an abdominal aortic aneurism (AAA). The treatment consisted in AAA's exclusion with a custom-made endograft device shaped on purpose with a dedicated branch allowing perfusion of the ectopic lower left kidney.

Hepatorenal Revascularization Enables Endovascular Aneurysm Repair on a Patient with Abdominal Aortic Aneurysm and an Ectopic Right Renal Artery

In last 30 years, the endovascular aneurysm repair (EVAR) has become the standard method of treatment of abdominal aortic aneurysms (AAAs). Nevertheless, the method has limitations mainly based on the anatomic characteristics of the specific aneurysm. In these cases, a combination of endovascular and open techniques can be used. We describe a case of a patient with an infrarenal AAA and an ectopic right renal artery emerging from within the aneurysm sac. The patient was treated with a combination of endovascular and open techniques. In particular, he underwent a hepatorenal revascularization followed by a standard EVAR procedure, with a successful final outcome. For the treatment of AAA disease, the combination of open and endovascular procedures can overcome difficulties, where a standard EVAR cannot be an option.

A staged repair of crossed fused renal ectopia with complex abdominal aortic and iliac aneurysms

Crossed fused renal ectopia in the presence of abdominal aortic aneurysms (AAAs) is a rare challenge to therapy. A 68-year-old man had a 6.9-cm AAA, a 6.6-cm left common iliac aneurysm, and a 3.2-cm right internal iliac aneurysm. He had multiple comorbidities and a right-sided crossed fused kidney supplied by two small renal arteries arising from the AAA. Aortorenal bypass with staged endovascular aneurysm repair was used to treat the aneurysmal disease. Two-stage open aortorenal bypass followed by endovascular repair for complex aneurysms is feasible in the rare patient with such a congenital anomaly.

Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia

Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature.