Preoperative and postoperative imaging as a surgical strategy and feedback on abdominal aortic aneurysm with horseshoe kidney: Case report

A 77-year-old man was diagnosed with an infrarenal abdominal aortic aneurysm coexisting with a horseshoe kidney detected on a computed tomography (CT) scan. Since the presence of three accessory renal arteries was confirmed, reconstruction for renal protection was done by performing transperitoneal laparotomy instead of endovascular treatment. After performing anastomosis of a Y-shaped artificial graft, the major accessory renal artery was reconstructed under intraoperative renal perfusion. We report a successful surgical repair without renal isthmus division, where only autologous blood transfusion was performed. Although a postoperative CT scan showed partial renal infarction, creatinine levels, indicative of renal function, were comparable to preoperative levels. Horseshoe kidney is the most common fusion defect of the kidneys with aberrant accessory renal arteries. Thus, clearly constructed images are key to establish an effective operative strategy. Furthermore, comparing preoperative and postoperative CT images could also provide important feedback on the accuracy of treatment strategy.