Aortic reconstruction in patients with horseshoe or ectopic kidneys

Area of Science:

• Vascular Surgery
• Nephrology
• Surgical Anatomy

Background:

• Aortic surgery presents unique challenges when concurrent renal anomalies like horseshoe or ectopic kidneys are present.
• These anomalies necessitate specialized preoperative assessment and surgical strategies to ensure patient safety and optimal outcomes.

Purpose of the Study:

• To outline essential preoperative evaluations and surgical techniques for aortic reconstruction in patients with renal anomalies.
• To highlight methods for preserving renal function and minimizing complications during complex aortic surgeries.

Main Methods:

• Preoperative computed tomography (CT) scans for aortic and renal anomaly delineation.
• Preoperative arteriography to identify multiple and anomalous renal arteries.
• Discussion of retroperitoneal versus transperitoneal approaches based on aneurysm type and abdominal conditions.
• Emphasis on renal preservation techniques, including mannitol/furosemide infusion and cold perfusion.
• Reimplantation of accessory renal arteries using the Carrel patch technique.

Main Results:

• The retroperitoneal approach offers advantages for specific aortic aneurysms (e.g., infrarenal without iliac involvement, thoracoabdominal) and "pancake" kidneys.
• Mobilizing the horseshoe kidney anteriorly and placing the graft posteriorly is recommended for the transperitoneal approach.
• Avoiding division of the horseshoe kidney isthmus and careful management of accessory renal arteries are crucial.
• Standard renal preservation methods and accessory artery reimplantation are effective.
• While perioperative morbidity may increase, survival rates for elective aortic reconstructions remain excellent.

Conclusions:

• Aortic surgery with renal anomalies requires meticulous preoperative planning, including advanced imaging and consideration of surgical approach.
• Effective renal preservation techniques and careful management of aberrant renal vasculature are critical for successful outcomes.
• Despite increased complexity and potential morbidity, elective aortic reconstruction in these patients offers excellent survival.