Symptomatic abdominal aortic aneurysm in a patient with a horseshoe kidney

Horseshoe kidney is the most common congenital renal anomaly, occurring in 0.15-0.25% of newborns. The association of a horseshoe kidney with an abdominal aortic aneurysm is rare. Only 0.12% of patients requiring abdominal aortic repair have a horseshoe kidney. This therapeutic challenge constitutes a patient presenting with a symptomatic abdominal aortic aneurysm and a horseshoe kidney. The horseshoe kidney was supplied by 4 renal arteries, 2 of which emerged from the aneurysmal sac. The patient underwent urgent open repair, with transperitoneal exposure, interposition of a bifurcated aorto-bi-iliac Dacron graft and re-implantation of the 2 anomalous renal arteries on the Dacron main body. Postoperatively, the patient was discharged from the intensive care unit on day 3, and discharged home on day 8, maintaining normal serum creatinine.

Keywords:
congenital abnormalities; aortic aneurysm; abdominal aortic aneurysm; fused kidney; kidney/abnormalities

Authorship

Geciana Maria Araujo Coelho

Universidade Federal do Amazonas, Hospital Universitário Francisca Mendes, Serviço de Cirurgia Vascular e Endovascular, Manaus, AM, Brasil.Universidade Federal do AmazonasBrasilManaus, AM, BrasilUniversidade Federal do Amazonas, Hospital Universitário Francisca Mendes, Serviço de Cirurgia Vascular e Endovascular, Manaus, AM, Brasil.

Universidade Federal do Amazonas – UFAM, Hospital Universitário Getúlio Vargas, Serviço de Cirurgia Vascular, Manaus, AM, Brasil.Universidade Federal do AmazonasBrasilAM, BrasilUniversidade Federal do Amazonas – UFAM, Hospital Universitário Getúlio Vargas, Serviço de Cirurgia Vascular, Manaus, AM, Brasil.

Ranielli Auxiliadora Assem França

Fundação Hospital Adriano Jorge – HUGV, Serviço de Cirurgia Geral, Manaus, AM, Brasil.Fundação Hospital Adriano JorgeBrasilManaus, AM, BrasilFundação Hospital Adriano Jorge – HUGV, Serviço de Cirurgia Geral, Manaus, AM, Brasil.

Renan Danilo Lima da Rocha

Mariana de Oliveira Pantoja

Patricia de Souza Lacerda

Jose Emerson dos Santos Souza

Universidade do Estado do Amazonas – UEA, Escola Superior de Ciências da Saúde, Departamento de Clínica Cirúrgica, Manaus, AM, Brasil.Universidade do Estado do AmazonasBrasilManaus, AM, BrasilUniversidade do Estado do Amazonas – UEA, Escola Superior de Ciências da Saúde, Departamento de Clínica Cirúrgica, Manaus, AM, Brasil.

Marcos Velludo Bernardes

Universidade Federal do Amazonas – UFAM, Faculdade de Medicina, Programa de Pós-graduação em Cirurgia - PPGRACI, Manaus, AM, Brasil.Universidade Federal do AmazonasBrasilManaus, AM, BrasilUniversidade Federal do Amazonas – UFAM, Faculdade de Medicina, Programa de Pós-graduação em Cirurgia - PPGRACI, Manaus, AM, Brasil.

Leonardo Pessoa Cavalcante

Universidade Federal do Amazonas – UFAM, Faculdade de Medicina, Departamento de Clínica Cirúrgica, Manaus, AM, Brasil.Universidade Federal do AmazonasBrasilManaus, AM, BrasilUniversidade Federal do Amazonas – UFAM, Faculdade de Medicina, Departamento de Clínica Cirúrgica, Manaus, AM, Brasil.

http://orcid.org/0000-0002-1390-6712

Conflicts of interest:

No conflicts of interest declared concerning the publication of this article.

Correspondence :
Leonardo Pessoa Cavalcante Universidade Federal do Amazonas, Hospital Universitário Francisca Mendes, Serviço de Cirurgia Vascular e Endovascular Av. Camapuã, 108 CEP: 69093-000 – Manaus (AM) - Brasil Tel.: +55 (92) 3649-2750 E-mail: leocavalcante@ufam.edu.br

Author information:

GMAC - Resident from Programa de Residência Médica em Cirurgia Vascular, Hospital Universitário Getúlio Vargas/Hospital Universitário Francisca Mendes, Universidade Federal do Amazonas (UFAM). RAAF - General surgeon from Programa de Residência Médica em Cirurgia Geral, Fundação Hospital Adriano Jorge. RDLR - Resident from Programa de Residência Médica em Cirurgia Vascular, Hospital Universitário Getúlio Vargas/Hospital Universitário Francisca Mendes, Universidade Federal do Amazonas (UFAM). MOP - General surgeon from Programa de Residência Médica em Cirurgia Geral, Fundação Hospital Adriano Jorge. PSL - Attending physician at Serviço de Cirurgia Vascular, Hospital Universitário Francisca Mendes/Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas (UFAM). JESS - Attending physician at Serviço de Cirurgia Vascular, Hospital Universitário Francisca Mendes, Universidade Federal do Amazonas (UFAM); professor at Departamento de Clínica Cirúrgica, Escola Superior de Ciências da Saúde da Universidade do Estado do Amazonas (ESA-UEA). MVB - Attending physician at Serviço de Cirurgia Vascular, Hospital Universitário Francisca Mendes, Universidade Federal do Amazonas (UFAM); MSc in Surgery from Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas (PPGRACI-UFAM). LPC - Attending physician at Serviço de Cirurgia Vascular, Hospital Universitário Francisca Mendes/Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas (UFAM); professor at Departamento de Clínica Cirúrgica, Faculdade de Medicina da Universidade Federal do Amazonas (FMUFAM) and Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas (PPGRACI-UFAM).

Author contributions :

Conception and design: GMAC, RAAF, RDLR, LPC Analysis and interpretation: MOP, PSL, JESS, MVB, LPC Data collection: GMAC, RAAF, RDLR, MOP Writing the article: GMAC, LPC Critical revision of the article: GMAC, RAAF, RDLR, MOP, PSL, JESS, MVB, LPC Final approval of the article*: GMAC, RAAF, RDLR, MOP, PSL, JESS, MVB, LPC Statistical analysis: N/A. Overall responsibility: LPC *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (7)

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Figure 1
Horseshoe kidney with fusion anterior to the abdominal aortic aneurysm.

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Figure 2
Schematic drawing illustrating arterial supply to the horseshoe kidney and the origins of the digestive arteries. *: Inferior mesenteric artery with high origin.

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Figure 3
Surgical exposure of the repaired aortic neck, the inferior mesenteric artery (arrow), and the two renal arteries (*) that emerged from the aneurysm sac (the renal isthmus has already been sectioned).

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Figure 4
Surgical exposure of the right iliac bifurcation (A) and the left iliac bifurcation (B).

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Figure 5
Surgical exposure of the renal isthmus before transection (A) and after transection (B).

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Figure 6
Surgical exposure revealing the proximal aortic anastomosis to the 18x9 mm Dacron graft, immediately below the origin of the inferior mesenteric artery (arrow) and reimplantation by patch of the two anomalous renal arteries onto the main body of the Dacron graft (*).

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Figure 7
Postoperative angiotomography showing patent arterial anastomoses, patent reimplanted renal arteries, and good contrast uptake in the renal parenchyma bilaterally, with the exception of the right lower renal pole.

Figure 1 Horseshoe kidney with fusion anterior to the abdominal aortic aneurysm.

Figure 2 Schematic drawing illustrating arterial supply to the horseshoe kidney and the origins of the digestive arteries. *: Inferior mesenteric artery with high origin.

Figure 3 Surgical exposure of the repaired aortic neck, the inferior mesenteric artery (arrow), and the two renal arteries (*) that emerged from the aneurysm sac (the renal isthmus has already been sectioned).

Figure 4 Surgical exposure of the right iliac bifurcation (A) and the left iliac bifurcation (B).

Figure 5 Surgical exposure of the renal isthmus before transection (A) and after transection (B).

Figure 6 Surgical exposure revealing the proximal aortic anastomosis to the 18x9 mm Dacron graft, immediately below the origin of the inferior mesenteric artery (arrow) and reimplantation by patch of the two anomalous renal arteries onto the main body of the Dacron graft (*).

Figure 7 Postoperative angiotomography showing patent arterial anastomoses, patent reimplanted renal arteries, and good contrast uptake in the renal parenchyma bilaterally, with the exception of the right lower renal pole.

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Symptomatic abdominal aortic aneurysm in a patient with a horseshoe kidney

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[1] Conflicts of interest:

No conflicts of interest declared concerning the publication of this article.