Pj. Ohara et al., SURGICAL-MANAGEMENT OF AORTIC-ANEURYSM AND COEXISTENT HORSESHOE KIDNEY - REVIEW OF A 31-YEAR EXPERIENCE, Journal of vascular surgery, 17(5), 1993, pp. 940-947
Purpose: The coexistence of horseshoe kidney and aortic aneurysm poses
a technical challenge to the vascular surgeon at the time of aneurysm
repair. Clinical experience with this problem was reviewed to assess
the results of treatment and to develop guidelines for the treatment o
f patients with horseshoe kidney and aortic aneurysm. Methods: From 19
60 through 1991, 19 patients with associated horseshoe kidney (HSK) re
quired repair of abdominal aortic aneurysm at the Cleveland Clinic. Se
venteen men and two women, with a mean age of 67 years, underwent 16 e
lective and three urgent operations. The HSK was found before operatio
n in 16 patients (84%), whereas the remaining three were discovered at
operation. Computed tomography and intravenous pyelography were the m
ost reliable means of preoperative diagnosis, whereas ultrasonography
and aortography were less dependable. Mean size of abdominal aortic an
eurysm was 6.1 cm. The mean preoperative creatinine level was 1.5 mg/d
l. The surgical approach was transperitoneal in 16 patients and retrop
eritoneal in three. Division of the renal isthmus was avoided in all p
atients. Results: Renal artery anomalies were encountered in 14 patien
ts (74%). Renal arterial continuity was established by a variety of te
chniques, including branch grafts or reimplantation into the aortic gr
aft. Abnormal preoperative renal function was associated with a signif
icantly increased risk for early postoperative hemodialysis (p = 0.02)
. There were three postoperative deaths, and the mortality rate for pa
tients who required dialysis (67%) was significantly higher (p = 0.05)
than that for patients who did not (6.3%). There were six late deaths
at a mean follow-up interval of 57 months. Conclusions: The most impo
rtant aspect of HSK, therefore, is the appropriate surgical management
of frequent renal artery anomalies. We currently believe this is best
achieved with retroperitoneal exposure.