Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, México.
Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada 2501 Sur, Tecnológico, Monterrey, Mexico.
J Endovasc Ther. 2022 Aug;29(4):637-645. doi: 10.1177/15266028211059447. Epub 2021 Nov 26.
A systematic review of all patients that have been reported in the literature with abdominal aortic aneurysm (AAA) concomitant with horseshoe kidney (HSK) treated electively by endovascular aneurysm repair (EVAR) is presented. A new grouping system for describing HSK vasculature is implemented.
We searched for published manuscripts using the Medical Subject Headings terms "abdominal aortic aneurysm," "AAA," "EVAR," "endovascular aneurysm repair," and "horseshoe kidney" in PubMed, Google Scholar, Scopus, and National Center for Biotechnology Information databases. Inclusion criteria include all published material of patients with AAA with HSK treated electively by an endovascular approach. We excluded patients who were treated by a hybrid or open repair or patients with ruptured AAA. Statistical analysis was carried out using SPSS Statistics version 25 (IBM Corp, Armonk, New York) software.
A total of 50 patients from 30 studies were included for analysis. Males made up 88% (n=44) of the population. The median age for this cohort was 70 years (range: 47-86 years). Median aneurysmal diameter was 6.0 cm (range: 4.0-10.3 cm). The median operative time for endovascular repair was 84 minutes (range: 40-332 minutes). The most common graft used was Zenith, used in 40% (n=20) of the cases, followed by Endurant in 14% (n=7). The overall complication rate was 14% (n=7). The median follow-up was 19 months (range: 1-108 months). While comorbidities did not appear to impact outcomes significantly, median operative times for smokers were higher than those in nonsmokers, 84 versus 118 minutes, respectively (p=0.048). Univariate linear regression modeling of aneurysmal size with age, operative time, and length of stay revealed a significant coefficient association between aneurysmal size and operative times. After adjusting for comorbidities and aneurysmal size, prior history of chronic kidney disease significantly increased odds for renal infarction.
This review presents the most complete data set possible of patients with concomitant HSK and AAA treated by an endovascular approach. Furthermore, the A + B + C classification for grouping the HSK vasculature is implemented. This systematic review suggests EVAR to be an excellent option with low complication rates for the treatment of AAA in patients with HSK.
对所有文献中报道的接受血管内动脉瘤修复术（EVAR）择期治疗的腹主动脉瘤（AAA）合并马蹄肾（HSK）患者进行系统回顾。提出了一种新的描述 HSK 血管系统的分组系统。
我们使用 Medical Subject Headings 术语“腹主动脉瘤”、“AAA”、“EVAR”、“血管内动脉瘤修复”和“马蹄肾”在 PubMed、Google Scholar、Scopus 和美国国立生物技术信息中心数据库中搜索已发表的文献。纳入标准包括所有接受血管内治疗的 HSK 合并 AAA 患者的发表材料。我们排除了接受杂交或开放修复或破裂 AAA 患者。使用 SPSS Statistics 版本 25（IBM 公司，纽约州阿蒙克）软件进行统计分析。
共有 30 项研究中的 50 名患者被纳入分析。该人群中男性占 88%（n=44）。该队列的中位年龄为 70 岁（范围：47-86 岁）。中位动脉瘤直径为 6.0cm（范围：4.0-10.3cm）。血管内修复的中位手术时间为 84 分钟（范围：40-332 分钟）。使用最常见的移植物是 Zenith，在 40%（n=20）的病例中使用，其次是 Endurant，占 14%（n=7）。总体并发症发生率为 14%（n=7）。中位随访时间为 19 个月（范围：1-108 个月）。虽然合并症似乎没有显著影响结果，但吸烟者的中位手术时间高于不吸烟者，分别为 84 分钟和 118 分钟（p=0.048）。对年龄、手术时间和住院时间与动脉瘤大小的单变量线性回归模型显示，动脉瘤大小与手术时间之间存在显著的系数相关性。在调整合并症和动脉瘤大小后，慢性肾脏病史显著增加了肾梗死的几率。
本综述提供了迄今为止最完整的 HSK 合并 AAA 患者接受血管内治疗的数据。此外，还实施了用于分组 HSK 血管系统的 A + B + C 分类。这项系统综述表明，EVAR 是治疗 HSK 患者 AAA 的一种极好的选择，并发症发生率低。
