ABDOMINAL AORTIC-ANEURYSM AND HORSESHOE K IDNEY - DIAGNOSIS AND THERAPY

The co-existence of horseshoe kidney (HSK) and abdominal aortic aneury sm (AAA) is rare and demands a special diagnostic workup and a meticul ous surgical procedure. Ten patients with HSK associated with AAA are reported. All underwent aortic replacement with successful preservatio n of multiple renal arteries. One patient died at the 7th postoperativ e day from myocardial infarction. HSK does not represent a contraindic ation for aortic repair. Angiography for identification of aberrant re nal arteries and classification into three types for surgical manageme nt is mandatory. In type I and II we recommend a standard midline tran speritoneal approach. Only in type III does a thoraco-abdominal approa ch seem favourable. The aortic reconstruction should be performed with tube grafts, if possible. Aberrant renal arteries are reattached dire ctly to the prosthesis. Dissection of renal isthmus should be avoided. Temporary cold renal perfusion is indicated to extend the ischemic to lerance time. As repair of a ruptured AAA in patients with HSK may be quite difficult and time consuming, we recommend more liberal indicati ons for aneurysm surgery in patients with HSK.