Endovascular Reconstruction of Aortoiliac Occlusive Disease with an Aberrant Pelvic Kidney

doi:10.1016/j.avsg.2015.09.017

Annals of Vascular Surgery

Volume 31, February 2016, Pages 208.e1-208.e4

https://doi.org/10.1016/j.avsg.2015.09.017 Get rights and content

Aortoiliac occlusive disease coincident with a congenital ectopic pelvic kidney is a rare occurrence. Traditionally, the treatment has been open aortobifemoral repair with reimplantation of the renal artery. We present a patient with Trans-Atlantic Inter-Society Consensus (TASC) D bilateral aortoiliac occlusive disease, an ectopic pelvic kidney, and prohibitive medical comorbidities. We describe a totally endovascular repair using a chronic total occlusion crossing device, a luminal re-entry device, and balloon-mounted covered stents to revascularize the lower extremities and the ectopic pelvic kidney. We discuss various aspects of this endovascular approach as the incidence of patients with TASC D lesions and prohibitive comorbidities continue to rise.

Section snippets

Case Report

A 63-year-old woman with a history of hepatitis C with cirrhosis, hepatocellular carcinoma, hypertension, intermittent stable angina, chronic kidney disease, and morbid obesity presented with progressive bilateral lower extremity pain for 2 years. The patient's symptoms progressed from intermittent claudication to constant bilateral lower extremity rest pain, along with a left great toe subcentimeter ulcer. Computed tomography angiography demonstrated severe occlusive disease of her aorta,

Discussion

Our patient presented with severe bilateral aortoiliac occlusive disease complicated by aberrant renal vasculature due to an ectopic right pelvic kidney. Preoperative renal perfusion study showed no significant renal artery stenosis of either kidney. We felt compelled to preserve the pelvic kidney as her estimated glomerular filtration rate had decreased to 63 and she was already in stage 2 chronic kidney disease. The combination of a congenital pelvic kidney with aortoiliac occlusive disease

References (23)

R.W. Chang et al.
Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease
J Vasc Surg
(2008)
L. Norgren et al.
Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)
J Vasc Surg
(2007)
M. Piazza et al.
Iliac artery stenting combined with open femoral endarterectomy is as effective as open surgical reconstruction for severe iliac and common femoral occlusive disease
J Vasc Surg
(2011)
S.S. Sabri et al.
Outcomes of covered kissing stent placement compared with bare metal stent placement in the treatment of atherosclerotic occlusive disease at the aortic bifurcation
J Vasc Interv Radiol
(2010)
A.T. Ali et al.
Emerging role of endovascular grafts in complex aortoiliac occlusive disease
J Vasc Surg
(2003)
V. Jongkind et al.
A systematic review of endovascular treatment of extensive aortoiliac occlusive disease
J Vasc Surg
(2010)
C. Klonaris et al.
Primary stenting for aortic lesions: from single stenoses to total aortoiliac occlusions
J Vasc Surg
(2008)
C.D. Leville et al.
Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients
J Vasc Surg
(2006)
K. Bjorses et al.
Kissing stents in the aortic bifurcation—a valid reconstruction for aorto-iliac occlusive disease
Eur J Vasc Endovasc Surg
(2008)
C.G. Krahn et al.
Aortoiliac occlusive vascular disease in association with congenital pelvic kidney
Ann Vasc Surg
(1993)

O. European Stroke et al.

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC)

Eur Heart J

(2011)

Cited by (3)

Endovascular reconstruction of aortoiliac occlusive disease in a case with claudication and an ectopic pelvic kidney
2022, Annals of Medicine and Surgery
Citation Excerpt :
However, it may cause significant symptoms like hypertension, urinary tract infections, or renal calculi [4]. Ectopic pelvic kidney coincident with the aortoiliac occlusive disease is rare [5]. A patient with iliac artery occlusion can present with a wide range of clinical symptoms, such as claudication and advanced symptoms of chronic ischemia like ulcers.
Ectopic kidney is a rare anomaly with an incidence of about 1 in 2500 birth in the population. Concurrency of pelvic kidney and iliac occlusion is rare, and the treatment is challenging because the pelvic kidney is associated with an atypical blood supply.
We reported a 68-year-old man with aortoiliac stenosis, right pelvic kidney, and high-risk cardiovascular comorbidities. He presented with the right lower extremity claudication that has been present for four years. Computed tomography angiograms showed total occlusion of right common and external iliac arteries.
The old method for treating iliac artery stenosis is open surgery, which needs cross-clamping of the aorta. During this procedure, the chance of renal thrombosis and ischemia is high. Thus, the patient underwent an endovascular angioplasty that was done successfully for the patient without any disturbances in kidney function.
Traditional treatment of iliac artery stenosis, especially in patients with high-risk cardiovascular comorbidities, may be associated with complications. Endovascular intervention is a safe and effective approach for treating aortoiliac occlusion in patients with ectopic pelvic kidneys. More research and case series are needed to review the results and compare the success rate of this method versus open surgery.
Aortoiliac occlusive disease associated with an ectopic pelvic kidney
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Case ReportEndovascular Reconstruction of Aortoiliac Occlusive Disease with an Aberrant Pelvic Kidney

Section snippets

Case Report

Discussion

J Vasc Surg

J Vasc Surg

J Vasc Surg

J Vasc Interv Radiol

J Vasc Surg

J Vasc Surg

J Vasc Surg

J Vasc Surg

Eur J Vasc Endovasc Surg

Ann Vasc Surg

Eur Heart J

Case Report
Endovascular Reconstruction of Aortoiliac Occlusive Disease with an Aberrant Pelvic Kidney