Toursarkissian B, Mejia A, Wholey M H, Lawler M A, Thompson I M, Sykes M T
Department of Surgery, University of Texas Health Science Center at San Antonio, 78229, USA.
J Endovasc Ther. 2001 Dec;8(6):604-8. doi: 10.1177/152660280100800613.
To report the endovascular exclusion of an abdominal aortic aneurysm (AAA) in a patient with a horseshoe kidney and an isthmus mass with preservation of accessory renal vessels.
A 70-year-old man with a 5-cm AAA and renal cell carcinoma involving a horseshoe kidney was treated with an AneuRx bifurcated graft. Two accessory renal arteries believed to feed the isthmus mass were sacrificed, but 2 other accessory renal arteries from the left common iliac artery (CIA) were preserved by using an extension cuff to cover the aneurysmal left CIA distal to their origins. The right renal isthmus mass decreased in size on follow-up imaging. At 9 months, there was no endoleak evident on computed tomographic scans, and the aneurysm measured 4.8 cm.
The presence of accessory renal arteries in AAA patients with horseshoe kidneys should not automatically exclude them from consideration for endovascular repair. Creative stent-graft arrangements can be a treatment option.
报告1例马蹄肾且峡部有肿块的患者，在保留副肾血管的情况下，通过血管内技术成功排除腹主动脉瘤（AAA）。
1例70岁男性患者，患有5cm的AAA及累及马蹄肾的肾细胞癌，采用AneuRx分叉型移植物进行治疗。2条被认为给峡部肿块供血的副肾动脉被牺牲，但通过使用延长袖套覆盖起源于左髂总动脉（CIA）远端的动脉瘤性左CIA，保留了另外2条来自左CIA的副肾动脉。随访影像学检查显示右肾峡部肿块体积减小。9个月时，计算机断层扫描未发现明显内漏，动脉瘤大小为4.8cm。
AAA合并马蹄肾患者存在副肾动脉时，不应自动将其排除在血管内修复的考虑范围之外。创造性的支架移植物布置可作为一种治疗选择。
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