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(Circulation. 2001;103:2126.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Endovascular Stent Graft Repair of an Infrarenal Abdominal Aortic Aneurysm With a Horseshoe Kidney

W. Anthony Lee, MD; Geoffrey D. Rubin, MD; Frank Arko, MD; Bradley B. Hill, MD; Christopher K. Zarins, MD

From the Stanford University Division of Vascular Surgery, Stanford, Calif.

Correspondence to Christopher K. Zarins, Stanford University Medical Center, 300 Pasteur Drive, Rm H36042, Division of Vascular Surgery, Stanford, CA 94305. E-mail zarins@stanford.edu

A78-year-old man was referred for treatment of a progressively enlarging, asymptomatic abdominal aortic aneurysm (AAA) and a left hypogastric artery aneurysm, which had been followed for 3 years with serial computed tomography (CT) scans. A helical CT angiogram was obtained using a 100 mL intravenous bolus of iodinated contrast medium (GE LightSpeed, 2.5 mm nominal section thickness, 6.0 pitch, 15 mm/rotation table speed, and reconstructed with 1.6 mm increment) (Figure 1).

View larger version (125K): [in this window] [in a new window]   Figure 1. CT angiogram. A, 5.2-cm infrarenal AAA with the isthmus of a horseshoe kidney draped over its anterior aspect. B, 6.2-cm left hypogastric artery aneurysm with a large crescentic mural thrombus.

Three-dimensional reconstructions were performed; they demonstrated the relationship of the horseshoe kidney to the aorta (Figure 2).

View larger version (26K): [in this window] [in a new window]   Figure 2. Color-enhanced surface-shaded rendering. A, Anterior view; B, posterior view. Note the 2 main renal arteries and an accessory renal artery coming off the right common iliac artery to supply the isthmus of the horseshoe kidney. A second, smaller accessory renal artery can be seen coming off directly from the aneurysm anteriorly; this is best seen in the posterior view (B). The left hypogastric artery aneurysm is also well visualized.

Detailed measurements of the infrarenal neck of the AAA and the distal landing zones demonstrated an anatomy suitable for endovascular stent graft repair of both aneurysms using the AneuRx bifurcated device (Medtronic). The proximal extent of the stent graft would be deployed in its usual infrarenal position, but the distal extent of the left limb of the device would . . . [Full Text of this Article]