Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
BMJ Case Rep. 2021 Jan 25;14(1):e236755. doi: 10.1136/bcr-2020-236755.
Horseshoe kidney, representing abnormal fusion of the inferior renal poles, is a rare anatomic anomaly posing challenges in the setting of surgical abdominal aortic aneurysm repair. Historically, open repair has been the favoured surgical approach. However, due to the location of the renal isthmus and wide-ranging variation in anomalous renal vasculature, endovascular aneurysm repair (EVAR) has emerged as a popular, less invasive alternative. We describe one of the first published cases of two-fenestration EVAR in a patient with concomitant horseshoe kidney, followed by a discussion of current trends in surgical management. With the increasing availability to customise fenestrated grafts to patients' unique anatomy, this advanced EVAR technique may emerge as the preferred approach in certain cases.
马蹄肾，代表下极肾脏融合的异常，是一种罕见的解剖异常，在外科治疗腹主动脉瘤时带来挑战。历史上，开放修复一直是首选的手术方法。然而，由于肾峡部的位置和异常肾血管的广泛变化，血管内修复（EVAR）已成为一种流行的、微创的替代方法。我们描述了首例合并马蹄肾的患者行两分支 EVAR 的病例，随后讨论了目前的手术治疗趋势。随着定制开窗移植物以适应患者独特解剖结构的日益普及，这种先进的 EVAR 技术可能在某些情况下成为首选方法。
