Schneider Joseph R, Patel Nilesh H, Kim Stanley, Verta Michael J
Vascular and Interventional Program of Cadence Health, Winfield, IL 60190.
Vascular and Interventional Program of Cadence Health, Winfield, IL 60190.
Ann Vasc Surg. 2014 Jul;28(5):1318.e1-6. doi: 10.1016/j.avsg.2013.10.023. Epub 2014 Jan 15.
Crossed fused renal ectopia and other similar renal anomalies are nearly always associated with major renal arterial, venous, and collecting system anomalies. These complicate both open repair and endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). We present a case of successful EVAR of an AAA with crossed fused renal ectopia.
A 76-year-old man was followed with an AAA and was also noted to have crossed fused renal ectopia. The aneurysm increased in diameter to 5.5 cm, and repair was recommended. Anatomy appeared challenging for open repair but also for EVAR because of a highly angulated neck and the major renal artery to the ectopic segment originating from the upper part of the aneurysm. However, EVAR appeared feasible if this renal artery could be sacrificed. Coil embolization of this renal artery was performed before EVAR. The patient's renal function was stable, and he suffered only a few days of abdominal pain. EVAR was performed 25 days later and required adjunctive procedures to eliminate a type 1 endoleak as had been feared because of the highly angulated neck. The patient suffered no decline in renal function and remained well 6 months later with no evidence for endoleak or other complication.
Renal anomalies present major challenges in aortic aneurysm repair. Preemptive sacrifice of a portion of the renal mass may allow successful repair without apparent deleterious effects.
交叉融合肾异位及其他类似的肾脏异常几乎总是与主要的肾动脉、静脉及集合系统异常相关。这些情况使腹主动脉瘤（AAA）的开放修复和血管腔内修复（EVAR）都变得复杂。我们报告一例成功对伴有交叉融合肾异位的AAA进行EVAR的病例。
一名76岁男性因AAA接受随访，同时被发现患有交叉融合肾异位。动脉瘤直径增大至5.5厘米，建议进行修复。由于颈部高度成角以及异位节段的主要肾动脉起源于动脉瘤上部，开放修复和EVAR的解剖结构似乎都具有挑战性。然而，如果可以牺牲这条肾动脉，EVAR似乎是可行的。在进行EVAR之前对该肾动脉进行了弹簧圈栓塞。患者的肾功能稳定，仅经历了几天的腹痛。25天后进行了EVAR，由于担心颈部高度成角会导致I型内漏，因此需要辅助操作来消除内漏。患者肾功能没有下降，6个月后情况良好，没有内漏或其他并发症的迹象。
肾脏异常在主动脉瘤修复中带来重大挑战。预先牺牲部分肾脏组织可能允许成功修复且无明显有害影响。
