5th International Conference on Heart and Cardiovascular Diseases

Karina I Garifullina is affiliated with S.S. Yudin City Clinical Hospital and I.M. Sechenov First Moscow State Medical University (Sechenov University), Russian Federation. Her professional work is associated with clinical medicine and academic healthcare

Introduction: The horseshoe kidney (HSK) is the most common congenital renal anomaly. It occurs in about 1 in 500 people and in about 0.12% of patients with abdominal aortic aneurysm (AAA). The position of the renal isthmus and variations in renal vascular anatomy may complicate surgical exposure and reconstruction.

Methodology: We present two open repairs in patients with AAA coexisting with HSK. Case 1: a 72-year-old man had an incidental infrarenal aneurysm (60 mm). The renal isthmus was supplied by one 4-mm accessory artery. The patient underwent aneurysm resection and aorto-bi-iliac reconstruction using synthetic graft, with reimplantation of an accessory renal artery into the graft. Case 2: a 78-year-old man presented with right common iliac aneurysm (77 mm) and a 45-mm cyst of the renal isthmus, it was supplied by one 3-mm and two 1-mm arteries. The patient underwent elective surgery comprising exploration of the HSK, resection of the renal isthmus cyst, resection of the AAA, and aortobifemoral reconstruction using synthetic graft. An accessory isthmic artery was reimplanted into the graft.

Findings: Case 1 was discharged on day 6 with preserved renal function. Case 2 developed transient azotemia and hematuria; a suspected urine leak from the right pelvis was managed with a ureteral stent, removed on day 9. Creatinine normalised by day 5; discharge was on day 13. At 3 and 6 months, both were asymptomatic with patent grafts and reimplanted arteries on CT. In Case 2, a hypoperfused area in the left isthmus suggested a segmental infarct, but there was no impairment of renal function.

Conclusion: The transperitoneal approach provided exposure of the aneurysm, iliac arteries, renal isthmus, and accessory renal vessels, facilitating vascular reconstruction and accessory artery reimplantation. The decision to reimplant an accessory isthmic artery greater than 2 mm was intended to reduce the risk of ischemic injury.