Aneurizma abdominalne aorte i „potkovičasti bubreg“ – otvoreni hirurški tretman
Sažetak
Uvod. Potkovičasti bubreg (PB) je urođena anomalija u embrionalnom razvoju bubrega, javlja se rano u trudnoći kada se oba bubrega nalaze u neposrednoj blizini, a posledica je abnormalne migracije nefrogenih ćelija. Prisustvo PB može komplikovati anteriorni pristup rekonstruktivnoj hirurgiji aorte i ilijačnih arterija, jer „most“ PB leži preko aorte. PB je često povezan sa anomalijom bubrežnih sudova. Prikaz bolesnika. Žena, stara 71 godinu, primljena je sa aneurizmom abdominalne aorte (AAA) prečnika 50 mm i PB, i više aberantnih bubrežnih krvnih sudova i subokludiranom levom bubrežnom arterijom vidljivom na nalazu multislajsne kompjuterizovane tomografije (MSCT). Operisana je klasičnom hirurškom metodom gde je urađena resekcija aneurizme sa implantacijom Dakronskog grafta bez presecanja istmusa. Pored toga, urađena je endarterektomija leve gornje renalne arterije, perfuzija prave zajedničke donje polarne renalne arterije i reimplantacija obe donje polarne renalne arterije. Koegzistencija PB i AAA retko je stanje koje predstavlja tehnički izazov za vaskularnog hirurga zbog abnormalne anatomije, težeg prilaza aneurizmi i varijabilne vaskularizacije bubrega, a posebno istmusa. Zaključak. Otvorena hirurška metoda lečenja AAA sa PB predstvlja uspešan način rešavanja ovog problema jer pruža dobar pristup aneurizmi i renalnim krvnim sudovima uz mogućnost očuvanja bubrežne cirkulacije i, posledično, sprečavanja bubrežne insuficijencije.
Reference
Doménech-Mateu JM, Gonzalez-Compta X. Horseshoe kidney: a new theory on its embryogenesis based on the study of a 16-mm human embryo. Anat Rec 1988; 222(4): 408‒17.
Doménech-Mateu JM, Gonzalez-Compta X. Horseshoe kidney: a new theory on its embryogenesis based on the study of a 16-mm human embryo. Anat Rec 1988; 222(4): 408‒17.
McIlhenny C, Scott RN. Abdominal aortic aneurysm in associa-tion with horseshoe kidney. Eur J Vasc Endovasc Surg 2002; 23(6): 556‒8.
Davidović L, Marković M, Ilic N, Koncar I, Kostić D, Simić D, et al. Repair of abdominal aortic aneurysms in the presence of the horseshoe kidney. Int Angiol 2011; 30(6): 534‒40.
Kin K, Takano H, Nakagawa T, Shirakawa Y. Hybrid Repair of an Abdominal Aortic Aneurysm: Debranching with Endovas-cular Aneurysm Repair in a Patient with Horseshoe Kidney. Ann Vasc Dis 2017; 10(1): 41‒3.
Chihara S, Fujino T, Matsuo H, Hidaka A. Surgical treatment of abdominal aortic aneurysm associated with horseshoe kidney: symphysiotomy using harmonic focus. Ann Thorac Cardiovasc Surg 2014; 20 Suppl: 922‒5.
Spear R, Maurel B, Sobocinski J, Perini P, Guillou M, Midulla M, et al. Technical note and results in the management of ana-tomical variants of renal vascularisation during endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2012; 43(4): 398‒403.
Ceulemans LJ, Duchateau J, Vanhoenacker FM, De Leersnyder J. The Therapeutic Implications of an Abdomianl Aortic Aneu-rysm with Coincident Horseshoe Kidney.Acta Chir Belg 2014; 114(1): 71‒4.
Ichikawa T, Kawada S, Koizumi J, Endo J, Iino M, Terachi T, et al. Major Venous Anomalies Are Frequently Associated With Horseshoe Kidneys. Circ J 2011; 75(12): 2872‒77.
Hajibandeh S, Hajibandeh S, Johnpulle M, Perricone V. Transperi-toneal repair of a juxtarenal abdominal aortic aneurysm and co-existent horseshoe kidney with division of the renal isth-mus. J Surg Case Rep 2015; 2015(10). pii: rjv134.
Carnicelli AP, Doyle A, Singh M. Hybrid repair of an ab-dominal aortic aneurysm in a patient with a horseshoe kidney. J Vasc Surg 2013; 57(4): 1113‒5.
Kaplan DB, Kwon CC, Marin ML, Hollier LH. Endovascular repair of abdominal aortic aneurysms in patients with congeni-tal renal vascular anomalies. J Vasc Surg 1999; 30(3): 407‒15.
Brown K, Robinson D, Bray A. Customized fenestrated endo-vascular graft repair of abdominal aortic aneurysm with con-comitant horseshoe kidney. Vascular 2014; 22(3): 193‒7.