Surgical management of aortic aneurysm and coexistent horseshoe kidney: Review of a 31-year experience Patrick J. O'Hara, MD, Albert G. Hakaim, MD *,

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Surgical management of aortic aneurysm and coexistent horseshoe kidney: Review of a 31-year experience Patrick J. O'Hara, MD, Albert G. Hakaim, MD *, Norman R. Hertzer, MD, Leonard P. Krajewski, MD, Geoffrey S. Cox, MD, Edwin G. Beven, MD Journal of Vascular Surgery Volume 17, Issue 5, Pages 940-947 (May 1993) DOI: 10.1016/0741-5214(93)90044-M Copyright © 1993 Society for Vascular Surgery and international Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Diagrammatic representation of horseshoe kidney anomaly and its relationship to abdominal aorta. Journal of Vascular Surgery 1993 17, 940-947DOI: (10.1016/0741-5214(93)90044-M) Copyright © 1993 Society for Vascular Surgery and international Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Examples of various imaging methods in different patients with abdominal aortic aneurysms and coexistent horseshoe kidneys. A, Intravenous pyelogram; note the abnormally located collecting system (arrow). B, Abdominal ultrasonogram; note horseshoe kidney (arrow) anterior to aneurysm. C, Computed tomogram; note horseshoe kidney (arrow) anterior to aneurysm. D, Transfemoral aortogram with intraarterial digital subtraction technique. Journal of Vascular Surgery 1993 17, 940-947DOI: (10.1016/0741-5214(93)90044-M) Copyright © 1993 Society for Vascular Surgery and international Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Bar graph demonstrates preoperative and postoperative mean serum creatinine levels for 15 patients undergoing aortic aneurysm resection in presence of coexistent horseshoe kidney. Three patients were excluded from analysis after week 1, when postoperative dialysis was instituted. Solid bars represent those patients with normal preoperative renal function. Journal of Vascular Surgery 1993 17, 940-947DOI: (10.1016/0741-5214(93)90044-M) Copyright © 1993 Society for Vascular Surgery and international Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Diagram of renal arterial patterns found in 19 patients with aortic aneurysms and coexistent horseshoe kidney. A, Four common patterns, each found in more than one patient. B-C, Seven uncommon patterns, each found in single patient. Journal of Vascular Surgery 1993 17, 940-947DOI: (10.1016/0741-5214(93)90044-M) Copyright © 1993 Society for Vascular Surgery and international Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Diagram of surgical exposure and reconstruction options. A, Transperitoneal exposure through midline abdominal incision. Dacron graft placed beneath renal isthmus and renal arterial branches reconstructed by implantation or bypass grafting. B, Retroperitoneal exposure through left thoracoabdominal incision. Dacron graft placed within aneurysm and renal arterial branches reconstructed by implantation. Journal of Vascular Surgery 1993 17, 940-947DOI: (10.1016/0741-5214(93)90044-M) Copyright © 1993 Society for Vascular Surgery and international Society for Cardiovascular Surgery, North American Chapter Terms and Conditions