Horseshoe Kidney Isthmus Infarction After Percutaneous Endovascular Aortic Aneurysm Repair

Melmer, Patrick D; Patel, Ankur R.; Biswas, Saptarshi; Borowicz, Mark R.

doi:10.7759/cureus.7279

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…14 In addition, some authors have suggested that an artery supplying a volume of up to 32% of total parenchyma could be occluded in patients with normal renal function 15 In this review, 14.2% (n=7) of the patients had renal infarction, with 1 of them resolving 2 weeks after the EVAR. 16 Dorffner et al 17 reported a patient who had a middle renal artery supplying the parenchymal bridge of the HSK, fully covering the artery with a stent-graft. A renal infarction of the section was diagnosed, but not renal impairment was seen at 6 month follow-up.…”

Section: Discussionmentioning

confidence: 99%

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

et al. 2021

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Purpose: A systematic review of all patients that have been reported in the literature with abdominal aortic aneurysm (AAA) concomitant with horseshoe kidney (HSK) treated electively by endovascular aneurysm repair (EVAR) is presented. A new grouping system for describing HSK vasculature is implemented. Materials and Methods: We searched for published manuscripts using the Medical Subject Headings terms “abdominal aortic aneurysm,” “AAA,” “EVAR,” “endovascular aneurysm repair,” and “horseshoe kidney” in PubMed, Google Scholar, Scopus, and National Center for Biotechnology Information databases. Inclusion criteria include all published material of patients with AAA with HSK treated electively by an endovascular approach. We excluded patients who were treated by a hybrid or open repair or patients with ruptured AAA. Statistical analysis was carried out using SPSS Statistics version 25 (IBM Corp, Armonk, New York) software. Results: A total of 50 patients from 30 studies were included for analysis. Males made up 88% (n=44) of the population. The median age for this cohort was 70 years (range: 47–86 years). Median aneurysmal diameter was 6.0 cm (range: 4.0–10.3 cm). The median operative time for endovascular repair was 84 minutes (range: 40–332 minutes). The most common graft used was Zenith, used in 40% (n=20) of the cases, followed by Endurant in 14% (n=7). The overall complication rate was 14% (n=7). The median follow-up was 19 months (range: 1–108 months). While comorbidities did not appear to impact outcomes significantly, median operative times for smokers were higher than those in nonsmokers, 84 versus 118 minutes, respectively (p=0.048). Univariate linear regression modeling of aneurysmal size with age, operative time, and length of stay revealed a significant coefficient association between aneurysmal size and operative times. After adjusting for comorbidities and aneurysmal size, prior history of chronic kidney disease significantly increased odds for renal infarction. Conclusion: This review presents the most complete data set possible of patients with concomitant HSK and AAA treated by an endovascular approach. Furthermore, the A + B + C classification for grouping the HSK vasculature is implemented. This systematic review suggests EVAR to be an excellent option with low complication rates for the treatment of AAA in patients with HSK.

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Section: Discussionmentioning

confidence: 99%

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

et al. 2021

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“…The most common challenges of aortic surgery and co‐existing HSK include the surgical approach, planning around isthmus and the preservation of blood supply to the kidney (Davidović et al, 2011). Endovascular or open approaches to the aorta are possible (Davidović et al, 2011; Davidovic et al, 2018; Melmer et al, 2020; Bowden & Roche‐Nagle, 2021; Fabiani et al, 2019; Loftus et al, 1998, Kaplan et al, 1999; Ruppert et al, 2004; Frego et al, 2007).…”

Section: Implications For Practicementioning

confidence: 99%

Horseshoe kidney: Morphologic features, embryologic and genetic etiologies, and surgical implications

et al. 2023

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The horseshoe kidney (HSK) is the most common congenital abnormality of the upper urinary tract with an incidence of approximately 1 in 500 in the general population. Although individuals with HSK are often asymptomatic, they are at increased risk for neoplasms, infections, ureteropelvic obstruction secondary to lithiasis or vascular compression. Direct injury from trauma is increased in these individuals as is the risk of intraoperative complications secondary to damage involving the typically complex renal or adrenal vascular supply.We briefly review etiological factors including renal and urinary system embryology, genetic mutations, abnormalities related to faulty cell signaling, aberrant cell migration, and other possible causes including environmental exposures and trauma. In addition, we call attention to factors that might influence the success of surgical procedures in patients with HSK. We argue that an understanding of possible etiologies of the HSK and its different subtypes may be useful when planning surgical procedures or considering risk–benefit ratios associated with different surgical options.We briefly present the organization of a HSK in a 100‐year‐old male demonstrating an unusual vascular supply discovered during a dissection laboratory session in a medical school anatomy course. We describe the structure of the HSK, the position and relationships of the HSK to other structures within the abdomen, and the associated vascular relationships.

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Fenestrated endovascular abdominal aortic aneurysm repair with concomitant horseshoe kidney

Bowden

Roche-Nagle

2021

BMJ Case Rep

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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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Horseshoe Kidney Isthmus Infarction After Percutaneous Endovascular Aortic Aneurysm Repair

Cited by 5 publications

References 7 publications

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

Horseshoe kidney: Morphologic features, embryologic and genetic etiologies, and surgical implications

Fenestrated endovascular abdominal aortic aneurysm repair with concomitant horseshoe kidney

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