Abdominal aortic aneurysm in association with horseshoe kidney.

The authors report 3 cases of infra-renal abdominal aortic aneurysms resected in the presence of horseshoe kidney. In all these cases the diagnosis of the renal anomaly was done before the aneurysmectomy. In the first case, the diagnosis of horseshoe kidney was done by an aortography. In the second case by a previous operation to remove an urinary calculi. Three years after this surgery the diagnosis of abdominal aortic aneurysm was done when a computed tomography, an intravenous pyelography and an aortography, confirmed the diagnosis of horseshoe kidney. The third case come to our hospital in the fourth day after an exploratory laparotomy done in another hospital, when was observed the aneurysm and the horseshoe kidney. The second case had two anomalous arteries. One of them arose from the aneurysm to the renal isthmus and the other one from the common iliac to the isthmus. The three patients had an uncomplicated postoperative course. Only in the second case we had the necessity to reattache an anomalous artery directly to the graft.     

Abdominal aortic aneurysm associated with horseshoe kidney

The optimal approach to abdominal aortic aneurysm with horseshoe kidney is still debated. We describe a successful abdominal aortic aneurysm repair through a left retroperitoneal approach in a 77-year-old woman with a horseshoe kidney.     

Abdominal aortic aneurysm and horseshoe kidney. Clinical cases

The concomitance of horseshoe kidney and abdominal aortic aneurysm is rare but represents an interesting challenge for vascular surgeons. The trouble is greater if the diagnosis is formulated intraoperatively and specially if it is an emergency operation for aortic rupture or fissuration. The surgeon's aim is to get to the aneurysm collar without damaging the kidney, the renal arteries or the urinary tract that often have an anomalous development. The authors make a review of the literature and describe three cases occurred out of 2558 prosthetic reconstructions due to abdominal aortic aneurysm.     

Abdominal aortic aneurysm in association with a congenital pelvic horseshoe kidney: sentinel report and technical consideration

A case of an abdominal aortic aneurysm in the presence of a congenital pelvic horseshoe kidney is described and the technical approach discussed. Renal function was preserved by 'double clamping' during the proximal anastomosis and infusing cold crystalloid into cannulated renal arteries originating from the aneurysm sac.     

Abdominal aortic aneurysm

An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the artery that is 1.5 times the diameter of the normal segment. The most common location for an aortic aneurysm is the infrarenal segment where a diameter that exceeds 3 cm in diameter is considered aneurysmal. Duplex ultrasonography and spiral computerized tomography are the imaging modalities most commonly performed to detect the longitudinal and transverse diameter of the aorta. The prevalence of AAA may be increasing. Smoking, male gender, and increasing age are the most powerful predictors of AAA. Considering the higher prevalence of hypertension, it is surprising that the prevalence of AAA among African-American men is 39% less than white men. The risk of rupture is independently associated with female gender, large initial aneurysm diameter, lower forced expiratory volume in the first second, current smoking, and higher mean blood pressure. Inflammation rather than atherosclerosis may be essential to the development of AAA. Treatment is directed at smoking cessation and control of blood pressure and lipids. Beta blockers (propranolol) have not been shown to modify aneurysm growth rates, but drop out rates in the studies have been high. Antibiotics do show a modest benefit. Surgery is generally performed when the aneurysm exceeds 5.5 cm in men. For women, an AAA size between 4.5 cm and 5.0 cm is recommended for elective repair.     

Abdominal aortic aneurysm

Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell infiltrate, neovascularisation, and production and activation of various proteases and cytokines contribute to the development of this disorder, although the underlying mechanisms are unknown. In this Seminar, we aim to provide an updated review of the pathophysiology, current and new diagnostic procedures, assessment, and treatment of abdominal aortic aneurysm to provide family practitioners with a working knowledge of this disorder.     

Abdominal aortic aneurysm associated with renal ectopia

This report describes a rare case of concurrent abdominal aortic aneurysm and bilateral renal ectopia. Preoperative work-up included intravenous pyelography and angiography to assess renal function, renal artery anatomy, and ureter position. Conventional surgery was performed without renal protection. No deterioration in postoperative renal function was observed.     

Abdominal aortic aneurysm repair results in aortic stiffening

Long-term follow-up studies show that all-cause mortality remains unchanged after repair of abdominal aortic aneurysm (AAA), possibly because of an increased cardiovascular risk in this high risk group. Repair of the AAA introduces a semirigid conduit into the circulation with unknown effects on the central aortic haemodynamics, such as pulse-wave velocity (PWV). One recent study revealed that a 1 m/s increase in PWV confers a 15% increased risk of cardiovascular events. We investigated whether central aortic haemodynamic changes resulting from AAA repair could be contributing to this excess cardiovascular risk.In nine patients undergoing endovascular aneurysm repair of infrarenal AAA who were assessed for changes in carotid-femoral PWV (cfPWV), mean cfPWV (n=9) was 10·3 m/s (SD 1·0) preoperatively. 1 week and 6 weeks postoperatively, mean cfPWV was 10·2 m/s and 11·2m/s, respectively (mean difference at 6 weeks 0·9m/s [95% CI 0·1–1·8], p=0·03).AAA repair appears to result in a functional stiffening of the aorta. A larger powered study is in progress to confirm this finding and also investigate whether this phenomenon is sustained in the long term. Intensive cardiovascular risk monitoring and pharmacomodulation may be indicated in this high-risk population.FundingBritish Heart Foundation.     

Abdominal aortic aneurysm associated with abdominal visceral diseases

Abdominal aortic aneurysm (AAA) occurs in advanced age. As such, its frequency has increased with the general ageing of the population as has the possibility of finding AAA associated with abdominal visceral disease, especially neoplasms. A malignant mass is present in 4% of patients who undergo aortic reconstruction for AAA. Since surgical treatment for both is often potentially life-threatening, the surgeon is faced with a series of treatment decisions concerning foremost timing of the operation. The main worry is that simultaneous treatment carries a potential risk of infection of the vascular graft. On the other hand, a 2-phase procedure is also burdened by risks linked to a second anaesthesia and a second surgical operation carried out on scar or contaminated tissue and the worsening of one of the 2 potentially life-threatening illnesses. In this situation endovascular treatment of an AAA may represent an advantageous alternative therapeutic strategy.