A Case of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney / 日本心臓血管外科学会雑誌

Horseshoe kidney is a common renal anomalies, but coexistence with abdominal aortic aneurysm (AAA) is rare. Horseshoe kidney may cause various technical difficulties of aneurysm repair. A 76-year-old man was referred to our hospital for treatment of AAA with a horseshoe kidney. Preoperative 3-dimensional computed tomography (3D-CT) scans showed a pair of normal renal arteries and 3 accessory renal arteries from the anterior wall to abdominal aorta just proximal to an aneurysm. At operation, the aneurysm was exposed through a transperitoneal approach, and artificial graft replacement was performed with a woven Dacron bifurcated graft preserving the renal isthmus. The accessory renal arteries were not reconstructed. The postoperative course was uneventful. Postoperative 3-D CT showed minor infarction of renal isthmus, but renal function was not impaired.

Operative Mortality and Long-Term Relative Survival Rate Following Surgery for Abdominal Aortic Aneurysms / 日本心臓血管外科学会雑誌

Surgery for abdominal aortic aneurysms (AAA, <i>n</i>=240) was reviewed in subgroups of ruptured AAA (RAAA, <i>n</i>=31), non-ruptured AAA with arteriosclerosis obliterans (AAA w/ASO, <i>n</i>=48), and non-ruptured AAA without ASO (AAA w/o ASO, <i>n</i>=161). The average follow-up period was 4.2 years (maximum 15.8 years) and the follow-up rate was 97%. Overall operative mortality rates were 41.9% in RAAA and 2.9% in non-ruptured AAA. Those were 6.3% in AAA w/ASO and 1.9% in AAA w/o ASO. The main causes of death in the long-term follow-up period were heart disease in 32%, malignant neoplasm in 22%, cerebrovascular accidents in 10% and renal failure in 10%, and miscellaneous. Only renal failure was related to operative risk factors. Relative survival rates excluding hospital death following surgery were 79% at 5 years and 0% at 10 years in RAAA; 74% at 5 years and 52% at 10 years in AAA w/o ASO; 95% at 5 years and 78% at 10 years in AAA w/ASO; 90% at 5 years and 70% at 10 years in non-ruptured AAA. These survival rates were lower than those found in the normal population, especially in AAA w/ASO. AAA w/ASO had more surgical risk factors of ischemic heart diseases and diabetes mellitus. Main causes of deaths were heart diseases, and renal failure during the long-term follow-up period was more predominant in AAA. It is important to follow all patients after surgery for AAA with special attention to heart disease and renal failure.