Horseshoe and pelvic kidneys associated with abdominal aortic aneurysms

The preoperative recognition of the existence of horseshoe or pelvic kidney with abdominal aortic aneurysm would greatly facilitate the proper operative care of these patients. Preoperative intravenous pyelography should be done routinely in all patients with abdominal aortic aneurysms. The diagnosis of an associated horseshoe or pelvic kidney can usually be established by this simple test if it is properly interpreted. If these anomalies are demonstrated or suspected, an aortogram should be performed to establish the status of the arterial supply to the kidneys. Some of the anomalous blood supply to the kidneys may not be apparent even after the aortogram. If the aneurysm can be resected without compromising the blood supply to the isthmus, this should be done and the aortic graft tunneled behind the isthmus [4]. However, if the isthmus has a large blood supply from the aneurysm and if division of this blood supply renders the isthmus ischemic, then the isthmus should be excised. In patients with pelvic kidney, to reduce ischemia to the kidney, aortic clamping time should be reduced to a minimum by completely freeing the aneurysm and dividing all the related lumbar arteries prior to aortic clamping.