SURGICAL-MANAGEMENT OF AORTIC-ANEURYSM AND COEXISTENT HORSESHOE KIDNEY - REVIEW OF A 31-YEAR EXPERIENCE

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.