Abdominal aortic aneurysm associated with horseshoe kidney

Management of aortic aneurysm in the presence of a horseshoe kidney

BACKGROUND

The coexistence of an aortic aneurysm and a horseshoe kidney poses a technical challenge to the vascular surgeon at the time of aneurysm repair. The aim of this review is to develop a guideline for the treatment of patients with this dual pathology.

METHOD

A literature review combined with local experience provided a total of 176 cases. These were divided into two groups: asymptomatic aneurysms (134) and ruptured aneurysms (42), both in combination with a horseshoe kidney.

RESULTS

Six types of operative approach were described: transperitoneal approach with or without separation of the renal isthmus, retroperitoneal approach, placement of a stent-graft, aneurysmal wrap and exploration without exclusion of the aneurysm. Diagnosis of the horseshoe kidney was made before operation in 81 per cent of patients in the asymptomatic group, and in 55 per cent (23 of 42) in the ruptured group. Computed tomography proved to be the most reliable diagnostic procedure. Occlusion of renal arteries originating from the aneurysm was reported in 51 per cent in the asymptomatic group, and in 74 per cent (23 of 31) in the ruptured group.

CONCLUSION

The preferred surgical options for asymptomatic patients with an aortic aneurysm and a horseshoe kidney are the placement of a stent-graft or a retroperitoneal approach; both avoid many of the technical difficulties related to the presence of the horseshoe kidney. The approach of choice for a ruptured aneurysm is transperitoneal. Separation of the renal isthmus should be avoided.

[Aortic aneurysm and horseshoe kidney--case report and collective review (author's transl)]

Based on the own experience and on an intesive study of the literature with a total of 52 patients with an aortic aneurysm and a horseshoe kidney the problems of operative treatment are discussed. The conclusion is made, that the treatment of this rare combination has its special difficulties in nearly 2/3 of all cases, but the same results as conventional surgery of aortic aneurysms, when the renal artery abnormalities are respected and treated with adequate vascular surgical skill.

Horseshoe kidney and abdominal aortic aneurysm

A case of horseshoe kidney and an abdominal aortic aneurysm is presented. The 32 previously described cases are reviewed and the diagnosis and management are discussed. The major factors influencing the operative approach to an aortic aneurysm associated with a horseshoe kidney concern the site of origin of the renal arteries, their number, and the portion of the kidney which each supplies.