Horseshoe kidney (HSK) is the most common renal fusion, which is characterized by three anatomic anomalies: ectopia, malrotation and vascular changes. Patients with HSK are prone to a variety of complications, genitourinary and non-genitourinary. In this paper, the anatomy of HSK is delineated with a great emphasis on its blood supply. After reviewing the literature, the arterial supply patterns found by each author were categorized according to the classification system proposed by Graves. The majority of HSKs were found to be supplied by renal arteries derived from the abdominal aorta below the isthmus or by vessels originating from the common iliac arteries. In addition, the abnormalities associated with HSK are highlighted and classified in anatomical variations, congenital anomalies as well as in pathologic conditions related to HSK.

Horseshoe kidney: a review of anatomy and pathology

This invention is a prosthetic device generally placed on the outside surface of the vessel or graft which then elutes antiproliferative drugs or agents from a drug-eluting matrix material. Methods of perivascular antiproliferative drug administration also are disclosed.

Apparatus and Methods for Preventing or Treating Failure of Hemodialysis Vascular Access and Other Vascular Grafts

https://www.jvascsurg.org/article/S0741-5214(98)70088-6/pdf

Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms

Background:

The coexistence of an aortic aneurysm and a horseshoe kidney poses a technical challenge to the vascular surgeon at the time of aneurysm repair The aim of this review is to develop a guideline for the treatment of patients with this dual pathology



Method:

A literature review combined with local experience provided a total of 176 cases These were divided into two groups: asymptomatic aneurysms (134) and ruptured aneurysms (42), both in combination with a horseshoe kidney



Results:

Six types of operative approach were described: transperitoneal approach with or without separation of the renal isthmus, retroperitoneal approach, placement of a stent-graft, aneurysmal wrap and exploration without exclusion of the aneurysm Diagnosis of the horseshoe kidney was made before operation in 81 per cent of patients in the asymptomatic group, and in 55 per cent (23 of 42) in the ruptured group Computed tomography proved to be the most reliable diagnostic procedure Occlusion of renal arteries originating from the aneurysm was reported in 51 per cent in the asymptomatic group, and in 74 per cent (23 of 31) in the ruptured group



Conclusion:

The preferred surgical options for asymptomatic patients with an aortic aneurysm and a horseshoe kidney are the placement of a stent-graft or a retroperitoneal approach; both avoid many of the technical difficulties related to the presence of the horseshoe kidney The approach of choice for a ruptured aneurysm is transperitoneal Separation of the renal isthmus should be avoided © 2001 British Journal of Surgery Society Ltd

Management of aortic aneurysm in the presence of a horseshoe kidney.

Endovascular repair of abdominal aortic aneurysms in patients with congenital renal vascular anomalies.

Horseshoe kidney complicates aortic aneurysm surgery in 1 of 200 cases. A patient with asymptomatic juxtarenal aortic aneurysm associated with a horseshoe kidney was successfully treated by stent graft placement. The kidney was supplied by 4 renal arteries. The proximal uncovered part of the stent graft was anchored across the origin of 1 renal artery. Another renal artery, arising from the aneurysmal sac, was occluded by the covered part of the stent graft. A kidney infarction developed postoperatively, which did not affect renal function or blood pressure. The patient was discharged from the hospital in good condition. Follow-up computed tomography and angiography confirmed a satisfactory result of the endovascular treatment.Arch Surg. 1997;132:316-317

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=SURG&articleId=596778&pdfFileName=archsurg_132_3_021.pdf

Juxtarenal Aortic Aneurysm Associated With a Horseshoe Kidney: Transfemoral Endoluminal Repair

Endovascular treatment of aneurysms of the abdominal aorta is based on intravascular bridging of the aneurysm using of an endovascular prosthesis. The prosthesis must be safely anchored above and below the sac of the aneurysm in the non-dilated artery. Therefore the indication of endovascular treatment depends on the morphology of the aneurysm. The objective of the work was to analyse the morphology of the aneurysm with regard to the possibility of endovascular treatment. The morphology of the aneurysm was evaluated with regard to the angiographic examination and examination by computed tomography. The following parameters were investigated: diameter and length of the proximal and distal neck, diameter of the sac in two planes, diameter and tortousity of the iliac arteries, tortousity of the infrarenal aorta. A total of 70 patients with aneurysms of the abdominal aorta were examined. The patients were divided into three groups according to the morphology of the aneurysm. I. infrarenal aneurysms not affecting common iliac artery (n = 20) 28.5%, II. infrarenal aneurysms affecting common iliac artery (n = 38) 54.2%, III. juxtarenal aneurysms regardless of the affection of common iliac arteries (n = 12) 17.1%. Of the total of 70 examined patients 24 (34.2%) with infrarenal aneurysm and 6 (8.57%) with juxtarenal aneurysm were suitable for endovascular treatment.

Endovascular treatment of abdominal aortic aneurysms. Morphology of aneurysms as one of the deciding indicating factors

The authors present their initial clinical experience with endovascular treatment of an aneurysm of the abdominal aorta using of a polyester covered spiral Z stent. Since May 1995 they treated by the endoluminal route 13 patients with aneurysms of the abdominal aorta and 1 patient with thoracic aneurysm. In patients with a subrenal aneurysm (n = 10) the stent graft was anchored below renal arteries origins. In patients with a juxtarenal aneurysm (n = 3) the stent graft was anchored across the renal arteries origins. All patients were followed up by angiography, computed tomography and ultrasonography. In one patient with a subrenal aneurysm dislocation of the stent graft during implantation occurred. In the remaining patients it proved possible to exclude the aneurysm successfully. One patient with an juxtarenal aneurysm died 6 days after surgery. The cause of death was not associated with the aneurysm or surgery. In patients with juxtarenal aneurysms the authors did not observe changes of renal functions or occlusion of the renal artery in the course of 12 months.

[Polyester-covered spiral Z stent. Initial clinical experience with endovascular treatment of aortic aneurysms].

The generally used model of prehepatic portal hypertension is based on stenosis of the portal vein closely before it enters the hepatic parenchyma. The modelling is performed in the open abdominal cavity, which distorts the subsequent development of the modelled disease. The objective of the presented work was to elaborate a new approach to modelling of PPH where the rise of pressure in the portal vein will be separated from the surgery and the pressure in the portal circulation will rise gradually. Equipment for external compression of the portal vein was used in sic minipigs. The equipment comprised an inflatable balloon fitted to a silicone clamp. The balloon was connected by means of a polyurethane catheter to a chamber (ELLA Port CS). The compression set was attached before operation to the portal vein. The second cannula attached to the chamber (ELLA Port CS) was inserted into the lienal vein. Seven days after surgery the authors began to model portal hypertension percutaneously without laparotomy by inflating the balloon inserted into the portal vein. The value of the portal pressure seven days after the onset of modelling was 17.69 +/- 0.76 mm Hg, as compared with 9.0 +/- 1.3 mm Hg before modelling was started. In all experimental animals prehepatic portal hypertension was induced, as was proved angiographically and by direct assessment of the portal pressure.

A new approach to modelling prehepatic portal hypertension. Preliminary experimental results

PURPOSE To evaluate the efficacy, feasibility and safety of interventional procedures in patients with hemodialysis shunts in retrospective analysis. We report the technical success rate and the midterm primary and secondary patency rate in our patients. MATERIAL AND METHODS Between April 1996 and May 1999 (35 months) we performed 129 interventional procedures on hemodialysis shunts in 87 patients (40 women and 47 men in age 22-88 years, mean age 67 years). We treated 46 occlusions and 83 stenoses. There were native fistulas--63 radiocephalic fistulas, 7 brachiocephalis fistulas, 1 brachiobasilic fistula, and hemodialysis grafts--14 vein allografts and 2 synthetic PTFE grafts. Indication for fistulography and intervention was decreasing efficacy of hemodialysis (in case of stenosis) or shunt occlusion. Patients were treated by means of percutaneous transluminal angioplasty, thrombolysis and percutaneous mechanical thrombectomy with hydrolyser or with thrombectomy basket. Stents were placed twice. Once in suboptimal result of local thrombolysis, second time in case of central venous stenosis. Follow up ranged from 0.3 to 35 months (mean 11 months). Nine patients were lost for follow up, 15 patients died during follow up. RESULTS Overall technical success rate was 84% (108 procedures, n = 129), technical success in cases of occlusion was 57% (27 procedures, n = 46), in stenoses treatment was 98% (81 procedures, n = 83). Overall primary patency rate in 6 months is 40% (n = 59), in 12 months 24% (n = 59) and in 2 years 5% (n = 59). The primary assisted patency rate and secondary patency rate is 95% (n = 59) in 6 months, 88% (n = 59) in one year and 73% (n = 59) in two years. CONCLUSION Repeated percutaneous interventional procedures in patient with hemodialysis shunts can extent shunt patency. Despite relatively low primary patency rate we can achieved good primary assisted or secondary patency rate in patients with stenoses of shunt.

Krajina A

Papers

Juxtarenal Aortic Aneurysm Associated With a Horseshoe Kidney: Transfemoral Endoluminal Repair

Endovascular treatment of abdominal aortic aneurysms. Morphology of aneurysms as one of the deciding indicating factors

[Polyester-covered spiral Z stent. Initial clinical experience with endovascular treatment of aortic aneurysms].

A new approach to modelling prehepatic portal hypertension. Preliminary experimental results

Surgical interventions in dialysis fistulae