Endovascular repair of abdominal aortic aneurysms in patients with congenital renal vascular anomalies

Purpose: The endovascular repair of abdominal aortic aneurysms (AAAs) has b een suggested as an alternative to conventional aortic reconstruction. The presence of anomalous renal vascular anatomy frequently necessitates specia l planning during conventional aortic replacement and may also create uniqu e challenges for endovascular repair. We analyzed our experience with 24 pa tients with variant renal vascular anatomies who underwent treatment with a ortic endografts to determine the safety and efficacy of this technique in this population. Methods: During a 6-year period, 204 patients underwent aortic endograft pr ocedures, 24 (11.8%) of of whom had variations in renal vascular anatomy. T here were 19 men and five women. Each of the 24 patients had variant renal vascular anatomy, which was defined by the presence of multiple renal arter ies (n = 32), with or without a renal parenchymal anomaly (horseshoe or sol itary pelvic kidney). Twenty patients underwent aneurysm repair with balloo n expandable polytetrafluoroethylene grafts, and the remaining patients und erwent endograft placement with self-expanding attachment systems. Eighteen patients underwent exclusion and presumed thrombosis of anomalous renal br anches to effectively attach the aortic endograft. The decision to sacrific e a supernumerary artery was made on the basis of the vessel size (<3 mm), the absence of coexisting renal insufficiency, and the expectation for succ essful aneurysm exclusion. Results: The successful exclusion of the AAAs was achieved in all the patie nts, with the loss of a total of 17 renal artery branches in 12 patients. S mall segmental renal infarcts (<20%) were detected in only six of the 12 pa tients with follow-up computed tomographic scan results, despite angiograph ic evidence of vessel occlusion at the time of endografting. No evidence of new onset hypertension or changes in antihypertensive medication was seen in this group. No retrograde endoleaks were detected through the excluded r enal branches on late follow-up computed tomographic scans. Serum creatinin e levels before and after endogafting were unchanged after the exclusion of the AAA in all but one patient with multiple renal branches. One patient h ad a transient rise in serum creatinine level presumed to be caused by cont rast nephropathy. Conclusion: On the basis of this experience, we recommend the consideration of endovascular grafting for patients with AAAs and anomalous renal vessel s when the main renal vascular anatomy can be preserved and when the loss o f only small branches (<3 mm) is necessitated in patients with otherwise no rmal renal functions.