RESUMO
The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54 mm and a right common iliac aneurysm of 45 mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma Ilíaco/complicações , Rim/anormalidades , Artéria Renal/anormalidades , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Humanos , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/cirurgia , Imageamento Tridimensional , Rim/diagnóstico por imagem , Masculino , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Reimplante , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report a case of thoracoabdominal aneurysm repair in a 44-year-old man with end-stage heart failure requiring an extracorporeal left ventricular assist device (LVAD). At the age of 31 years, the patient experienced type B acute aortic dissection, which gradually dilated to a maximum dimension of 66 mm at the diaphragm. The aneurysm prevented the patient from meeting heart transplantation criteria. For this reason and because of an increased risk of rupture, we undertook surgical repair of the aneurysm. This report constitutes the first such published case, and we describe the management of the LVAD in the perioperative period.
