RELEVANCE OF HORSESHOE KIDNEY IN SURGERY OF ABDOMINAL AORTIC ANEURYSMS

Bemd Luther, MD, Wilhelm Sandmann, MD, SuhnyAbbara, MD, Klaus Grabitz, MD, Lutz Reiher, MD
Department of Vascular Surgery and Kidney Transplantation,
Heinrich-Heine University,
Dusseldorf, Germany

The horseshoe kidney (HSK) is a rare embryonic abnormality which is characterised by its variability in vascular structures. We report on 11 patients with abdominal aortic an-eurysm (AAA) in combination with a horseshoe kidney in a retrospective study of 1705 AAA of the last 15 years. The aortic reconstruction with preservation of renal perfusion was successful in all cases, so that a horseshoe kidney as such should not be a contraindication for vessel reconstruction. However, there are special demands in diagnostics, in operative access, in aortic reconstruction, and in prevention of renal ischemia. The most valuable diagnostic method is digital subtraction angiography, which permits identification of the accessory renal arteries and thereby differentiation into 3 blood supply variants. Type I and II should be operated by a ventral, transperitoneal approach. Type III with a single artery arising from the aortic aneu- rysm can be managed by the same way. However, if there are multiple arteries arising from the aneurysm in a type 111 horseshoe kidney, a left-sided thoraco-abdominal incision with an extraperitoneal, dorse-lateral aortotomy is recommended. The prosthetic reconstruction of the aorta should be done under preservation of the kidney isthmus with a short interponate (tube graft). Step by step all the major renal arteries are reimplanted. In the thoraco-abdominal reconstruction, the reinsertion of the renal arteries will be performed with the graft-inclusion technique. We do temporarily use cooled, hepariniydflush-perfusion solution, containing prostaglandine E, to prolong the renal ischemia tolerance. In ruptured AAA with a horseshoe kidney the mortality and morbidity are very high. Thus earlier reconstruction of AAA in patients with horseshoe kidney should be considered.

P. 70

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