Abdominal aortic aneurysm and autosomal dominant polycystic kidney disease.

Aim: The aim of this study was to report a series of patients with autosoma l dominant polycystic kidney disease operated for abdominal aortic aneurysm . Patients and methods: From 1986 to 1999, seven patients with this pathologi c association were operated for aneurysm by the same surgeon. All were male s, 47 to 69 years old (mean: 57.7). All were hypertensive and heavy smokers . Four were treated by hemodialysis. In five patients, the aneurysm was an incidental discovery, while two patients presented signs of obstructive art erial disease of the lower limbs. Ultrasound was the routine screening inve stigation, completed by aortography in all patients and by computed tomogra phy in 2 patients. Surgical treatment consisted of intrasaccular repair of the aneurysm with a straight aortic tube (n = 5), a bifurcated prosthesis f rom the aorta to both common iliac arteries (n = 1) and a bifurcated prosth esis from the aorta to both common femoral arteries (n = 1). Results:There was no postoperative mortality or morbidity. Two late deaths (at 5 and 8 years) occurred from myocardial infarction. Only one patient su bsequently received a kidney transplant. Repairs were verified by postopera tive angiography: anatomical results were satisfactory in all patients. Onl y nine similar cases have been published in the literature, including two d eaths from ruptured aneurysm. Conclusions :The clinical diagnosis of aortic aneurysm is difficult in pati ents with polycystic kidneys due to renal volume. Ultrasound scan of the ao rta is recommended to screen these patients for aneurysm. The data of our s eries show that the main cause of aortic aneurysms is atheroma and that a p athogenic link between this lesion and polycystic kidney disease is questio nable. Elective aortic repair is recommended in order to avoid rupture of t he aneurysm. (C) 2000 Editions scientifiques et medicales Elsevier SAS.