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Aortic stent grafting may be an alternative to surgery for patients with an abdominal aortic aneurysm and coexistent horseshoe kidney but is not without difficulties. This study examines the renal consequences of aortic stent grafting in such patients. This is a retrospective review of patients with horseshoe kidney in whom aortic stent grafting was performed between December 1995 and August 2000. Follow-up occurred within the EUROSTAR protocol and included measurement of serum creatinine. Of 130 patients in whom aortic stent grafting was performed, 4 had coexistent horseshoe kidney. In all patients the aneurysm was successfully excluded with the occlusion of between one and four anomalous renal arteries. At follow-up, no clinically significant renal impairment was detected. Endovascular aneurysm repair is an attractive option for patients with a horseshoe kidney and normal preoperative creatinine levels.

The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectively embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.

SummaryThe present report describes a case of an extrahepatic right hepatic artery pseudoaneurysm caused by acalculous cholecystitis. An 85-year-old man was admitted with abdominal pain, cachexia and jaundice. A CT scan showed a saccular false right hepatic artery aneurysm within a soft tissue and fluid mass that was causing biliary obstruction. The soft tissue mass raised the possibility of malignant disease, but this resolved slowly after a period of time and on reviewing the patient's history the only upper gastrointestinal problem noted was an episode of acalculous cholecystitis 3 months previously, which was believed to be the cause of the pseudoaneurysm. The false aneurysm was treated successfully with coil embolisation and the patient recovered fully from this illness. BACKGROUND

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