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Kawatani Y, Yamasaki M, Oguri A. Endovascular aortic aneurysm repair with reversed chimney graft technique in a patient with crossed fused renal ectopia: a technical note. J Surg Case Rep 2021; 2021:rjab272. [PMID: 34168859 PMCID: PMC8219392 DOI: 10.1093/jscr/rjab272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
Crossed fused renal ectopia is a very rare congenital ectopia and poses great challenges when performing abdominal aortic surgery because of the accompanying abnormal vessels and urinary tracts. A 79-year-old woman with an abdominal aortic aneurysm and L-shaped crossed fused renal ectopia was referred to our facility. One of the large ectopic renal arteries arose from the right common iliac artery. The aneurysm was treated with an endovascular aortic repair. The reversed chimney graft technique was applied to preserve the ectopic renal artery while elongating the distal landing zone on the right side. The patient experienced no complications such as renal dysfunction or recurrence of the abdominal aortic aneurysm during the 6-month follow-up period.
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Affiliation(s)
- Yohei Kawatani
- Department of Cardiovascular Surgery, Takasaki Heart Hospital, Takasaki, Japan
| | - Motoshige Yamasaki
- Department of Cardiovascular Surgery, Takasaki Heart Hospital, Takasaki, Japan
| | - Atsushi Oguri
- Department of Cardiology, Takasaki Heart Hospital, Takasaki, Japan
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Bowden S, Roche-Nagle G. Fenestrated endovascular abdominal aortic aneurysm repair with concomitant horseshoe kidney. BMJ Case Rep 2021; 14:14/1/e236755. [PMID: 33495175 PMCID: PMC7839873 DOI: 10.1136/bcr-2020-236755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Horseshoe kidney, representing abnormal fusion of the inferior renal poles, is a rare anatomic anomaly posing challenges in the setting of surgical abdominal aortic aneurysm repair. Historically, open repair has been the favoured surgical approach. However, due to the location of the renal isthmus and wide-ranging variation in anomalous renal vasculature, endovascular aneurysm repair (EVAR) has emerged as a popular, less invasive alternative. We describe one of the first published cases of two-fenestration EVAR in a patient with concomitant horseshoe kidney, followed by a discussion of current trends in surgical management. With the increasing availability to customise fenestrated grafts to patients' unique anatomy, this advanced EVAR technique may emerge as the preferred approach in certain cases.
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Affiliation(s)
- Sylvie Bowden
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Department of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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Ertugay S, Posacioglu H, Bozkaya H, Parildar M. Chimney technique for solitary pelvic kidney. Interact Cardiovasc Thorac Surg 2020; 31:743-744. [PMID: 32888009 DOI: 10.1093/icvts/ivaa154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
The combination of solitary pelvic kidney and abdominal aortic aneurysm is extremely rare. In this report, we present chimney graft implantation in a patient with solitary pelvic kidney. A 63-year-old man had the diagnosis of infrarenal abdominal aortic aneurysm made incidentally. Preoperative computed tomography illustrated a fusiform abdominal aortic aneurysm accompanying a solitary ectopic kidney in the pelvis with aberrant renal artery. A bifurcated endograft was implanted, and a covered stent graft was placed into the renal artery by use of the chimney technique. Good patency of the chimney graft was documented with early postoperative and first month scans. To the best of our knowledge, this is the first report of the chimney technique used in a solitary pelvic kidney.
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Affiliation(s)
- Serkan Ertugay
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Hakan Posacioglu
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Halil Bozkaya
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Parildar
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
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Bernard C, Leboffe M, Garcia J, Steinmetz E, Cheynel N. Lessons for the clinical nephrologist: a rare case of unfused renal ectopia. J Nephrol 2020; 34:251-253. [PMID: 32725497 DOI: 10.1007/s40620-020-00814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Chloé Bernard
- Departement of Cardiovascular and Thoracic Surgery, Dijon University Hospital, France, 2, Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France.
- Departement of Anatomy, University of Burgundy Medical School, Dijon, France.
| | - Mélanie Leboffe
- Departement of Cardiovascular and Thoracic Surgery, Dijon University Hospital, France, 2, Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Jairo Garcia
- Departement of Cardiovascular and Thoracic Surgery, Dijon University Hospital, France, 2, Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Eric Steinmetz
- Departement of Cardiovascular and Thoracic Surgery, Dijon University Hospital, France, 2, Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Nicolas Cheynel
- Departement of Anatomy, University of Burgundy Medical School, Dijon, France
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Date Y, Takano T, Fujii T, Terasaki T, Sakaguchi M. Double D Technique: An Innovative Modified Bifurcated Stent Graft Deployment Strategy for an Isolated Common Iliac Artery Aneurysm With a Challenging Renal Artery Anatomy. Vasc Endovascular Surg 2019; 53:613-616. [PMID: 31307324 DOI: 10.1177/1538574419862671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. CASE REPORT An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. CONCLUSION Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.
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Affiliation(s)
- Yusuke Date
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Tamaki Takano
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Taishi Fujii
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Takamitsu Terasaki
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Masayuk Sakaguchi
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
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Management and therapeutic options for abdominal aortic aneurysm coexistent with horseshoe kidney. J Vasc Surg 2019; 69:1257-1267. [DOI: 10.1016/j.jvs.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
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Lazaris AM, Moulakakis K, Mantas G, Poulou K, Alexiou E, Vasdekis S, Geroulakos G. Hepatorenal Revascularization Enables Endovascular Aneurysm Repair on a Patient with Abdominal Aortic Aneurysm and an Ectopic Right Renal Artery. Ann Vasc Surg 2018; 52:316.e1-316.e5. [PMID: 29886214 DOI: 10.1016/j.avsg.2018.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
- Andreas M Lazaris
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece.
| | - Konstantinos Moulakakis
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgios Mantas
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Katerina Poulou
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Evangelos Alexiou
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Spyros Vasdekis
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgios Geroulakos
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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Bianchini Massoni C, Azzarone M, Barbarisi D, Perini P, Freyrie A. Ruptured Abdominal Aortic Aneurysm in a Patient with Congenital Fused Pelvic Kidney: A Case Report of Emergency Endovascular Treatment. AORTA (STAMFORD, CONN.) 2018; 6:21-27. [PMID: 30079933 PMCID: PMC6136674 DOI: 10.1055/s-0038-1636992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 90-year-old male developed acute onset of abdominal and lumbar pain due to the rupture of an 11-cm abdominal aortic aneurysm. A congenital fused pelvic kidney perfused by three renal arteries arising from iliac axes was detected. In an emergent setting, an aorto-uni-iliac endograft was deployed through right femoral surgical access with occlusion of the upper right renal artery. An occluder device was placed in the common iliac artery above the renal artery through left femoral access. A femorofemoral crossover bypass completed the procedure. The patient developed acute renal failure, with no dialysis necessity. One-month computed tomography angiography showed procedure success.
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Affiliation(s)
- Claudio Bianchini Massoni
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Matteo Azzarone
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Danilo Barbarisi
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Perini
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery - Department of Surgical Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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