Management of aortic aneurysm in the presence of a horseshoe kidney

Background: The coexistence of an aortic aneurysm and a horseshoe kidney po ses a technical challenge to the vascular surgeon at the time of aneurysm r epair. The aim of this review is to develop a guideline for the treatment o f patients with this dual pathology. Method: A literature review combined with local experience provided a total of 176 cases. These were divided into two groups: asymptomatic aneurysms ( 134) and ruptured aneurysms (42), both in combination with a horseshoe kidn ey. Results: Six types of operative approach were described: transperitoneal ap proach with or without separation of the renal isthmus, retroperitoneal app roach, placement of a stent-graft, aneurysmal wrap and exploration without exclusion of the aneurysm. Diagnosis of the horseshoe kidney was made befor e operation in 81 per cent of patients in the asymptomatic group, and in 55 per cent (23 of 42) in the ruptured group. Computed tomography proved to b e the most reliable diagnostic procedure. Occlusion of renal arteries origi nating from the aneurysm was reported in 51 per cent in the asymptomatic gr oup, and in 74 per cent (23 of 31) in the ruptured group. Conclusion: The preferred surgical options for asymptomatic patients with a n aortic aneurysm and a horseshoe kidney are the placement of a stent-graft or a retroperitoneal approach; both avoid many of the technical difficulti es related to the presence of the horseshoe kidney. The approach of choice for a ruptured aneurysm is transperitoneal. Separation of the renal isthmus should be avoided.