title: Endovascular AAA repair in a patient with a horseshoe kidney and an isthmus mass.
abstract: OBJECTIVE
  To report the endovascular exclusion of an abdominal aortic aneurysm (AAA) in a patient with a horseshoe kidney and an isthmus mass with preservation of accessory renal vessels.
  
  
  METHODS
  A 70-year-old man with a 5-cm AAA and renal cell carcinoma involving a horseshoe kidney was treated with an AneuRx bifurcated graft. Two accessory renal arteries believed to feed the isthmus mass were sacrificed, but 2 other accessory renal arteries from the left common iliac artery (CIA) were preserved by using an extension cuff to cover the aneurysmal left CIA distal to their origins. The right renal isthmus mass decreased in size on follow-up imaging. At 9 months, there was no endoleak evident on computed tomographic scans, and the aneurysm measured 4.8 cm.
  
  
  CONCLUSIONS
  The presence of accessory renal arteries in AAA patients with horseshoe kidneys should not automatically exclude them from consideration for endovascular repair. Creative stent-graft arrangements can be a treatment option.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, 78229, USA. toursarkiss@uthscsa.edu
authors.forename: B
authors.initials: B
authors.lastname: Toursarkissian
authors.forename: A
authors.initials: A
authors.lastname: Mejia
authors.forename: M H
authors.initials: MH
authors.lastname: Wholey
authors.forename: M A
authors.initials: MA
authors.lastname: Lawler
authors.forename: I M
authors.initials: IM
authors.lastname: Thompson
authors.forename: M T
authors.initials: MT
authors.lastname: Sykes
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000098:blood supply / Q000601:surgery; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009392:Nephrectomy; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging; D015607:Stents