Maiorano Francesco, Duarte António, Lopes Alice, Amorim Pedro, Martins Carlos, Pedro Luís Mendes
Department of Vascular Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
EJVES Vasc Forum. 2024 Mar 4;61:99-103. doi: 10.1016/j.ejvsvf.2024.02.004. eCollection 2024.
Horseshoe kidney (HK) is an anatomical variant characterised by abnormalities in the position, rotation, and vascular supply of the kidney, with functioning renal masses on both sides of the vertebral column fused together at the isthmus. Due to the altered pattern of kidney vasculature, endovascular aortic repair for aortic abdominal aneurysm (AAA) in the presence of HK requires vascular anatomy specific planning.
A 68 year old male, with multiple comorbidities, presented with an asymptomatic AAA and HK. The kidney vasculature was characterised by the presence of three arteries: two arising laterally at the same level and a third polar artery arising from below. The polar artery was 6 mm in diameter and larger than the other two; therefore, in order to preserve this artery, a custom-made device with a single side branch was implanted below the main renal arteries. A balloon expandable covered stent was used to complete the side branch into the polar renal artery. The follow-up computed tomography angiography revealed a successful outcome, with total aneurysm exclusion, branched graft patency, no endoleak, and unchanged renal function.
This case report shows a possible surgical solution for a case of HK with AAA and the importance of accurate endovascular planning. Large polar arteries, if present, need to be preserved, and custom-made devices in the modern endovascular era permit that. This approach could represent the best option for complicated patients.
马蹄肾（HK）是一种解剖变异，其特征在于肾脏的位置、旋转和血管供应异常，脊柱两侧的功能性肾块在峡部融合在一起。由于肾脏血管模式的改变，在存在马蹄肾的情况下，腹主动脉瘤（AAA）的血管内主动脉修复需要针对血管解剖结构进行特定规划。
一名68岁男性，患有多种合并症，因无症状性腹主动脉瘤和马蹄肾前来就诊。肾脏血管的特征是有三条动脉：两条在同一水平从侧面发出，第三条极动脉从下方发出。极动脉直径为6毫米，比另外两条动脉粗；因此，为了保留这条动脉，在肾动脉主干下方植入了一个带有单侧分支的定制装置。使用球囊可扩张覆膜支架完成向极肾动脉的侧支。随访计算机断层扫描血管造影显示结果成功，动脉瘤完全排除，分支移植物通畅，无内漏，肾功能未改变。
本病例报告展示了一例马蹄肾合并腹主动脉瘤病例可能的手术解决方案以及精确血管内规划的重要性。如果存在粗大的极动脉，需要予以保留，而现代血管内时代的定制装置允许这样做。这种方法可能是复杂患者的最佳选择。
