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Surgical treatment of abdominal aortic aneurysms associated with horseshoe kidney
Onur Göksel1, Bayer Cinar, Gürkan Kömürcü
1Department of Cardiovascular Surgery, Istanbul Medical Faculty, University of Istanbul, Istanbul, Turkey. onurgokseljet@gmail.com
Insights
Surgery for abdominal aortic aneurysms (AAA) in patients with horseshoe kidney (HSK) is complex. This study found that AAA surgery in HSK patients had slightly longer aortic clamp times but similar outcomes and mortality rates compared to non-HSK patients.
Area of Science:
- Vascular Surgery
- Abdominal Aortic Aneurysm
- Congenital Anomalies
Background:
- Horseshoe kidney (HSK) presents unique surgical challenges during abdominal aortic aneurysm (AAA) repair.
- Managing AAA in patients with HSK requires careful preoperative planning and surgical technique.
Purpose of the Study:
- To evaluate the surgical outcomes and technical considerations of AAA repair in patients with coexisting horseshoe kidney.
- To compare the safety and efficacy of AAA surgery in patients with and without HSK.
Main Methods:
- Retrospective review of 127 patients undergoing elective AAA repair between 1990 and 2004.
- Analysis of pre- and perioperative data, including imaging, surgical details, and patient outcomes.
- Comparison of outcomes between seven patients with HSK and 120 patients without HSK.
Main Results:
- No hospital mortality was observed in the HSK group, compared to five deaths in the non-HSK group.
- Aortic clamp times were slightly longer in the HSK group (30.43 ± 3.55 min) versus the non-HSK group (27.04 ± 3.92 min; p < .05).
- Reimplantation of the anomalous renal artery was required in five HSK patients; the left retroperitoneal approach provided adequate exposure without division of the isthmic tissue.
Conclusions:
- Abdominal aortic aneurysm repair in patients with horseshoe kidney can be managed safely and effectively.
- The left retroperitoneal approach is suitable for AAA repair in HSK patients.
- Horseshoe kidney does not significantly increase perioperative complications or mortality in AAA surgery.
Abstract:
Abdominal aortic aneurysm surgery associated with a horseshoe kidney (HSK) is a serious technical challenge for the surgeon. We reviewed our experience with 127 patients electively operated on between 1990 and 2004 for abdominal aortic aneurysm. Pre- and perioperative medical, surgical, and radiologic data were retrospectively reviewed. Preoperative diagnosis was achieved with computed tomography with or without angiography or with additional conventional aortography. Seven patients were recognized to have had a HSK, with a mean age of 67.29 +/- 2.43 years. Preoperative serum creatinine levels were similar in patients with or without HSK (1.0 +/- 0.08 vs 0.9 +/- 0.12 mg/dL; not significant). In five of the patients with HSK, reimplantation of the anomalous renal artery was necessary. In all 127 patients, hospital mortality consisted of 5 patients, none of whom had an HSK. Dealing with HSK seemed to increase aortic clamp times (30.43 +/- 3.55 vs 27.04 +/- 3.92 minutes; p < .05) slightly. Patients with or without HSK were given similar amounts of intravenous fluid replacement (2,214.2 +/- 441.3 vs 1,923.3 +/- 433.6 mL/patient; not significant) and allogeneic blood transfusion (0.71 +/- 0.49 vs 0.9 +/- 0.4 U/patient; not significant) and had a similar intensive care unit stay. Abdominal aortic aneurysms associated with HSK have been managed without division of the isthmic tissue. The left retroperitoneal approach provided adequate exposure for all patients with HSK.
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