Temporary perfusion of a congenital pelvic kidney during abdominal aortic aneurysm repair.

A patient with a large abdominal aortic aneurysm was noted to have a congenital pelvic kidney. The patient also had bilateral iliac aneurysms that required repair. The blood supply of the congenital pelvic kidney was not apparent from preoperative studies but was found at the time of surgery to be from the area of the aortic bifurcation. Pelvic renal ischemia was limited by a "double proximal clamping" technique and by placement of a temporary shunt from the body of the aortic graft into the pelvic renal artery during completion of two distal anastomoses. The patient's renal function remained normal during the perioperative period, and the reconstruction was demonstrated to be patent more than one year after surgery. Although simple clamping and expeditious reconstruction are appropriate in most cases of aortic surgery in the presence of congenital or transplant pelvic kidney, more complex anatomy, including iliac aneurysms, may require longer periods of ischemia. Pelvic renal ischemia may be limited with the technique described.