Surgical management of aortic aneurysm and coexistent horseshoe kidney: Review of a 31-year experience

Patrick J. O'Hara, Albert Hakaim, Norman R. Hertzer, Leonard P. Krajewski, Geoffrey S. Cox, Edwin G. Beven

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Purpose: The coexistence of horseshoe kidney and aortic aneurysm poses a technical challenge to the vascular surgeon at the time of aneurysm repair. Clinical experience with this problem was reviewed to assess the results of treatment and to develop guidelines for the treatment of patients with horseshoe kidney and aortic aneurysm. Methods: From 1960 through 1991, 19 patients with associated horseshoe kidney (HSK) required repair of abdominal aortic aneurysm at the Cleveland Clinic. Seventeen men and two women, with a mean age of 67 years, underwent 16 elective and three urgent operations. The HSK was found before operation in 16 patients (84%), whereas the remaining three were discovered at operation. Computed tomography and intravenous pyelography were the most reliable means of preoperative diagnosis, whereas ultrasonography and aortography were less dependable. Mean size of abdominal aortic aneurysm was 6.1 cm. The mean preoperative creatinine level was 1.5 mg/dl. The surgical approach was transperitoneal in 16 patients and retroperitoneal in three. Division of the renal isthmus was avoided in all patients. Results: Renal artery anomalies were encountered in 14 patients (74%). Renal arterial continuity was established by a variety of techniques, including branch grafts or reimplantation into the aortic graft. Abnormal preoperative renal function was associated with a significantly increased risk for early postoperative hemodialysis (p = 0.02). There were three postoperative deaths, and the mortality rate for patients who required dialysis (67%) was significantly higher (p = 0.05) than that for patients who did not (6.3%). There were six late deaths at a mean follow-up interval of 57 months. Conclusions: The most important aspect of HSK, therefore, is the appropriate surgical management of frequent renal artery anomalies. We currently believe this is best achieved with retroperitoneal exposure.

Original languageEnglish (US)
Pages (from-to)940-947
Number of pages8
JournalJournal of Vascular Surgery
Volume17
Issue number5
DOIs
StatePublished - 1993
Externally publishedYes

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Aortic Aneurysm
Abdominal Aortic Aneurysm
Renal Artery
Kidney
Transplants
Aortography
Mortality
Fused Kidney
Replantation
Urography
Aneurysm
Blood Vessels
Renal Dialysis
Dialysis
Ultrasonography
Creatinine
Tomography
Guidelines
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Surgical management of aortic aneurysm and coexistent horseshoe kidney : Review of a 31-year experience. / O'Hara, Patrick J.; Hakaim, Albert; Hertzer, Norman R.; Krajewski, Leonard P.; Cox, Geoffrey S.; Beven, Edwin G.

In: Journal of Vascular Surgery, Vol. 17, No. 5, 1993, p. 940-947.

Research output: Contribution to journalArticle

O'Hara, Patrick J. ; Hakaim, Albert ; Hertzer, Norman R. ; Krajewski, Leonard P. ; Cox, Geoffrey S. ; Beven, Edwin G. / Surgical management of aortic aneurysm and coexistent horseshoe kidney : Review of a 31-year experience. In: Journal of Vascular Surgery. 1993 ; Vol. 17, No. 5. pp. 940-947.
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abstract = "Purpose: The coexistence of horseshoe kidney and aortic aneurysm poses a technical challenge to the vascular surgeon at the time of aneurysm repair. Clinical experience with this problem was reviewed to assess the results of treatment and to develop guidelines for the treatment of patients with horseshoe kidney and aortic aneurysm. Methods: From 1960 through 1991, 19 patients with associated horseshoe kidney (HSK) required repair of abdominal aortic aneurysm at the Cleveland Clinic. Seventeen men and two women, with a mean age of 67 years, underwent 16 elective and three urgent operations. The HSK was found before operation in 16 patients (84{\%}), whereas the remaining three were discovered at operation. Computed tomography and intravenous pyelography were the most reliable means of preoperative diagnosis, whereas ultrasonography and aortography were less dependable. Mean size of abdominal aortic aneurysm was 6.1 cm. The mean preoperative creatinine level was 1.5 mg/dl. The surgical approach was transperitoneal in 16 patients and retroperitoneal in three. Division of the renal isthmus was avoided in all patients. Results: Renal artery anomalies were encountered in 14 patients (74{\%}). Renal arterial continuity was established by a variety of techniques, including branch grafts or reimplantation into the aortic graft. Abnormal preoperative renal function was associated with a significantly increased risk for early postoperative hemodialysis (p = 0.02). There were three postoperative deaths, and the mortality rate for patients who required dialysis (67{\%}) was significantly higher (p = 0.05) than that for patients who did not (6.3{\%}). There were six late deaths at a mean follow-up interval of 57 months. Conclusions: The most important aspect of HSK, therefore, is the appropriate surgical management of frequent renal artery anomalies. We currently believe this is best achieved with retroperitoneal exposure.",
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