Hybrid Repair of an Abdominal Aortic Aneurysm: Debranching with Endovascular Aneurysm Repair in a Patient with Horseshoe Kidney

Abstract

Abdominal aortic aneurysm (AAA) with associated horseshoe kidney (HSK) poses a technical challenge when performing conventional open surgical repair because of possible complications including renal infarction, neuralgia, and collecting system disruption. Endovascular aortic repair (EVAR) is considered the first-line treatment for this pathology, allowing for aneurysm repair without isthmus bisection. However, whether to sacrifice commonly presenting aberrant renal arteries during EVAR is a point of controversy. We report a case in which hybrid repair was performed for AAA to preserve aberrant renal vasculature in a patient with HSK.

Abdominal aortic aneurysm and horseshoe kidney-open surgical repair: A case report

“…Kaplan et al 12 noted that accessory vessels over 3 mm in diameter should be reattached in order to reduce the risk of postoperative renal insufficiency. The newest reports 5,11 demonstrated cases in which hybrid surgical repair was performed for AAA in a patient with HSK and aberrant renal vasculature, including EVAR after debranching aberrant renal arteries. EVAR is regarded as a valuable alternative to open surgical therapy in the absence of renal failure, provided that accessory renal arteries are absent or small 8 .…”

“…However, whether to sacrifice commonly presenting aberrant renal arteries during EVAR is a point of controversy. Some authors recommended a hybrid treatment 5 . We report one case of open repair AAA with HSK, with aberrant renal arteries and its reattachment without dividing the renal isthmus.…”

Management and therapeutic options for abdominal aortic aneurysm coexistent with horseshoe kidney

“…39,40,44 Cases of hybrid repair, combining EVAR and open surgical management, have also been reported in the literature. In such a case, Kin et al 48 treated a patient with the deployment of a bifurcated Excluder (W. L. Gore & Associates, Flagstaff, Ariz) endograft after reimplantation of a large aberrant renal artery originating from the left common iliac artery to the external iliac artery through interposition of a great saphenous vein graft. In another report, Carnicelli et al 49 performed reimplantation of two accessory renal arteries to the right external iliac artery through a Dacron graft, followed by endovascular application of a Zenith (Cook Medical, Bloomington, Ind) endograft for a 5.3-cm infrarenal AAA repair.…”

Horseshoe Kidney Isthmus Infarction After Percutaneous Endovascular Aortic Aneurysm Repair

“…Percutaneous endovascular aneurysm repair (PEVAR) adds to this with further minimally invasive advances. EVAR has been shown to be an effective strategy with good outcomes for patients with HSK [1,2]. Even so, extreme caution should be undertaken given the challenging nature of these patients.…”