title: Endovascular aneurysm repair in a patient with a horseshoe kidney and impaired renal function.
abstract: BACKGROUND
  We present the case of an 80-year-old female with a three-week history of lower backache and a pulsatile mass in her epigastrium.
  
  
  METHODS
  Using CT angiogram, the presence of an infra-renal abdominal aortic aneurysm (AAA) and co-existent horseshoe kidney was confirmed.
  
  
  RESULTS
  Due to associated multiple co-morbidities of hypertension, moderate renal failure, COPD and morbid obesity, she underwent endovascular aneurysm repair (EVAR).
  
  
  CONCLUSIONS
  The presence of a horseshoe kidney (HSK) poses significant difficulty during open repair of an AAA, as satisfactory anatomical exposure of the aorta may prove potentially hazardous. This problem may be circumvented in suitable cases by endovascular repair, although treatment is not risk free. EVAR is usually only recommended if renal function is normal. We report a case of AAA coexistent with an HSK and moderate renal impairment, which was treated successfully using an EVAR technique, and with no subsequent renal complication.
authors.affiliation: Dept of Vascular Surgery & Radiology, Royal Free Hospital, London, UK. surgeon1wrh@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: N
authors.initials: N
authors.lastname: Ahmed
authors.forename: J
authors.initials: J
authors.lastname: Tibbals
authors.forename: G
authors.initials: G
authors.lastname: Hamilton
mesh_terms: D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney / Q000002:abnormalities*; D007674:Kidney Diseases / Q000453:epidemiology*; D009767:Obesity, Morbid / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012077:Renal Artery / Q000002:abnormalities; D015607:Stents; D016896:Treatment Outcome