Case ReportsTemporary perfusion of a congenital pelvic kidney during abdominal aortic aneurysm repair*
Section snippets
Case report
A 61-year-old white man was found to have an 8 cm AAA by ultrasonography. A preoperative arteriogram revealed that the large infrarenal AAA also involved both common iliac arteries. A left pelvic kidney was present (Fig. 1).The arterial supply of the pelvic kidney could not be determined with certainty from the arteriogram because of dilution of the
Discussion
Congenital pelvic kidneys are thought to result from failure of normal ascent of the kidneys during fetal development.1 Accordingly, their blood supply is highly variable and may include multiple renal arteries arising from the distal aorta, aortic bifurcation, iliac arteries, or iliac branches2, 3 Based on autopsy experience, congenital pelvic kidneys occur with an incidence of approximately 1 in 3000.1 Because 33,000 to 34,000 AAA repairs are performed annually in nonfederal hospitals in the
Acknowledgements
The line drawing (Fig. 2) was prepared by Joan Thompson.
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Cited by (26)
Peculiar patterns of aortic pathology: diagnosis and best treatment
2021, Vascular Surgery: A Clinical Guide to Decision-makingManagement of Aortoiliac Aneurysms with Atypical Renal Artery Anatomy
2019, Annals of Vascular SurgeryOpen Surgical Repair of Aortoiliac Aneurysm, Left Pelvic Kidney and Right Kidney Malposition with Aberrant Vascularization, and Compressive Syndrome
2015, Annals of Vascular SurgeryCitation Excerpt :Clinicians have described many maneuvers intended to protect transplanted pelvic kidneys, including the use of temporary aortofemoral or axillofemoral Gott shunt, permanent or temporary axillofemoral bypass before infrarenal aortic cross-clamping, partial cardiopulmonary bypass in situ cold perfusion, and the technique of proximal double clamping (which enables retrograde perfusion of the kidney by collateral circulation during construction of the proximal aortic anastomosis). The congenital pelvic kidney is associated with a normal and functional contralateral kidney, so protective measures need to be less substantial.4 We have been encouraged by some previous reports that showed standard surgical techniques that did not have particularly strict renal protection measures in maintaining pelvic kidney function during aortic reconstruction.5
Preemptive coil occlusion of major aberrant renal artery to allow endovascular repair of abdominal aortic aneurysm with crossed fused renal ectopia
2014, Annals of Vascular SurgeryCitation Excerpt :In addition to arterial anomalies the venous anomalies in crossed fused ectopia tend to be more pronounced and more challenging to any open intervention for AAA. Various methods for renal preservation have been devised for open repair with congenital ectopic kidney or pelvic renal transplant,7,8,14,17 but these adjunctive measures may not be possible because of immobility of a fused renal mass, multiple small renal arteries, venous and collecting system anomalies, or other factors. Had the fused renal mass been on the right instead of the left, then open repair from a left retroperitoneal approach would have been a more favored option.
Chronic type B dissecting aortoiliac aneurysm repair complicated by congenital pelvic kidney
2008, Journal of Vascular SurgeryCitation Excerpt :A radiological study has shown that 0.18% of patients undergoing major aortic procedures have pelvic renal kidneys.3 Our literature search has identified a total of nine cases of aortic aneurysm replacement in the presence of a congenital pelvic kidney.4-10 However, there have been no previous reports of repair of a dissecting aortic aneurysm in the presence of a pelvic kidney.
Renal Function after Elective Infrarenal Aortic Aneurysm Repair in Patients with Pelvic Kidneys
2007, Annals of Vascular SurgeryCitation Excerpt :However, Hollis et al.2 reported one patient in whom they found a 6% loss of renal function in the congenital pelvic kidney. Unlike a transplanted pelvic kidney, the congenital pelvic kidney most often has multiple renal arteries (six of seven reported cases), one of which may originate from the diseased distal aorta, mandating an additional third anastomosis prior to reestablishing pelvic kidney flow.1-4 Of our four patients with a transplanted pelvic kidney who underwent open repair, all developed significant, albeit largely transient, rises in creatinine value.
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Reprint requests: Joseph R. Schneider, MD, PhD, Division of Vascular Surgery, Northwestern University Medical School, 100 Burch Hall, Evanston Hospital, 2650 Ridge Ave., Evanston, IL 60201.