The Renal Impact of Aortic Stent-Grafting in Patients with a Horseshoe Kidney

Jackson, Ralph; Fay, Dominic; Wyatt, Michael G.; Rose, John

doi:10.1007/s00270-003-0114-x

Cited by 22 publications

(20 citation statements)

References 13 publications

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“…Slight but permanent impairment of renal function was recently reported in three of four patients with HSK, in whom one to four minor accessory renal arteries were excluded during stent-graft positioning. 16 Obviously, HSK with multiple or important renal arteries arising from the aortic neck, the aneurism sac, or the iliac arteries cannot benefi t from this type of procedure. Moreover, a case of fatal type II endoleak from an excluded accessory renal artery was reported, which prompted some surgeons to deliberately occlude the accessory renal artery with coil embolization before attempting AAA endoluminal repair.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Aneurysm with Coexistent Horseshoe Kidney

Frego

Angriman

et al. 2007

Surg Today

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Surgical repair of an abdominal aortic aneurysm (AAA) concomitant with a horseshoe kidney (HSK) may be technically demanding because of the complex anomalies of the kidney and of its collecting system and arteries, the greater risk of HSK-related complications, and the often unexpected intraoperative finding of HSK itself. We reviewed a database of more than 500 patients with AAA observed in our surgical department from 1994 to the time of writing. Five patients had AAA concomitant with HSK. Two of these patients did not undergo surgery because of the small dimension of the aneurysm or because of their poor health. The other three underwent successful repair of AAA with different techniques; namely, an aortobifemoral bypass via a thoracoabdominal retroperitoneal incision in one, a straight graft via an emergency median laparotomy in one, and an endovascular repair followed by open surgery 4 years later for endotension in one. Abnormal minor renal arteries were deliberately occluded and only one of these caused a minor renal infarct, but without functional impairment. These data and a review of the literature indicate that HSK should not preclude repair of coexistent AAA, as imaging procedures provide the information necessary to plan the best approach for each patient. Up-to-date surgical procedures, a posteriori retroperitoneal approach or endovascular repair, and deliberate occlusion of the minor renal arteries appear feasible and safe as they avoid most of the anatomical problems and provide results equivalent to those of uncomplicated aortic surgery.

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Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Aneurysm with Coexistent Horseshoe Kidney

Frego

Angriman

et al. 2007

Surg Today

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“…More than half of patients with CFE and a third of patients with HK have other urogenital, gastrointestinal, cardiopulmonary, skeletal, or chromosomal anomalies [6,7]. The variations of vascular supply [8] could make kidney surgery [9], kidney transplants [10], or surgical [11] and endovascular procedures on the aorta [12] difficult. Thus, imaging is very important, but a systematic analysis of the findings of all methods, especially of spiral CT, in conjunction with the relevant clinical data, is still lacking.…”

Section: Introductionmentioning

confidence: 99%

Kidney fusion anomalies revisited: clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney

Glodny¹,

Petersen²,

Hofmann³

et al. 2008

BJU International

168

126

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OBJECTIVE To analyse the morphological appearance of horseshoe kidneys (HKs) and crossed fused ectopia (CFE) and to assess the frequency and clinical significance of associated anomalies and diseases. PATIENTS AND METHODS The findings and images of 209 patients with fused kidneys (FKs) were reviewed; in all, 244 scans from computed tomography (CT), 233 ultrasonograms and 89 micturition cysto‐urethrograms, urograms, magnetic resonance images and angiograms were taken. RESULTS HKs (found in one of 474 abdominal CT scans) and CFEs (found in one of 3078 CT scans) showed a high variability of vasculature that could not be classified. However, some generalized conclusions were possible about the renal vasculature (430 arteries in 103 kidneys). Variants of the most cephalad artery of both sides were rare. The second artery on the right had a pre‐caval course. The origins of vessels located further caudal were more ventral. CFEs were anatomically different from HKs with respect to lower position, greater axial rotation, smaller pelvic width, more caudal origin, and fewer vessels, but not in accompanying anomalies. Severe anomalies or malformations were found in 23% of patients, with half of them in the urogenital system. Malformations were found considerably more often in children than in adults. There was no increased incidence of diseases such as stones or inflammation of the renal pelvis. CONCLUSION Concomitant anomalies and diseases were equally frequent for HK and CFE, but less frequent than generally assumed. Individual cases of complex anatomical situations require special examination strategies, and CT appears to be the most reliable imaging method.

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“…2 It is not yet clear how many of these anomalous arteries and to what extent they can be safely covered. 7 Empirically, Jackson et al 6 suggested that an artery supplying up to 32% of the total parenchyma can be occluded in patients with normal renal function. Morphological evaluation with associated functional information can be done by a scintigraphic study that is able to give information about the parenchymal renal functional through capture and excretion of the radionucloide.…”

Section: Discussionmentioning

confidence: 99%

“…6 These features would determine lesions of the organ, which do not influence its function. 2 It is not yet clear how many of these anomalous arteries and to what extent they can be safely covered.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of an Abdominal Aortic Aneurysm in a Patient with Horseshoe Kidney: Report of a Case

et al. 2006

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Horseshoe kidney is a rare congenital anomaly that may cause various technical problems during conventional repairs of abdominal aortic aneurysms. We report the case of a 68-year-old woman with a horseshoe kidney, symptomatic abdominal aortic aneurysm and mild renal failure. The patient underwent endovascular repair using a bifurcated endoprosthesis. The postoperative was uneventful. We describe the diagnosis and the endovascular technique and literature review. Descriptors: Aortic aneurysm. Aortic aneurysm, abdominal/ surgery. Blood vessel prosthesis implantation/methods. Kidney diseases/surgery. Kidney/abnormalities. Stents. Resumo O rim em ferradura é uma anomalia congênita rara que pode causar várias dificuldades técnicas durante a correção convencional de aneurisma de aorta abdominal. Relatamos o caso de uma paciente de 68 anos com rim em ferradura, aneurisma de aorta abdominal sintomático e disfunção renal leve. A paciente foi submetida a correção endovascular, sendo utilizada uma endoprótese bifurcada. O pós-operatório foi livre de complicações. O diagnóstico e a técnica endovascular são discutidos, assim como a literatura revisada. Descritores: Aneurisma aórtico. Aneurisma da aorta abdominal/cirurgia. Implante de prótese vascular/métodos. Nefropatias/cirurgia. Rim/anormalidades. Contenedores.

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The Renal Impact of Aortic Stent-Grafting in Patients with a Horseshoe Kidney

Cited by 22 publications

References 13 publications

Abdominal Aortic Aneurysm with Coexistent Horseshoe Kidney

Abdominal Aortic Aneurysm with Coexistent Horseshoe Kidney

Kidney fusion anomalies revisited: clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney

Endovascular Repair of an Abdominal Aortic Aneurysm in a Patient with Horseshoe Kidney: Report of a Case

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