An 81-year-old man presented to our urology outpatient clinic with lower urinary tract symptoms.
She had a history of hypertension treated with angiotensin converting enzyme inhibitors, surgical intervention of duodenal ulcus in 1961 and cholecystectomy in 2002.
Aneurysm of the infrarenal abdominal aorta is incidentally diagnosed on ultrasound scans performed with barefoot.
Median CT was found not to affect the iliac bifurcation.
Likewise, in this exploration kidneys with morphology compatible with horseshoe kidneys, with isthmus located at the level of the infrarenal abdominal aorta are observed.
Our case reveals the situation, in principle, more favorable at the time of the surgical approach, since the aneurysm originates distally at 4 cm from the exit of the main renal arteries, which are two half, one for each one.
There is no additional artery at the level of the isthmus.
In successive controls, a progressive increase in aortic diameter was observed, which, in a control CT scan, had reached a maximum diameter of 8 cm.
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If these findings are present, the vascular surgery service decides to consider surgical treatment of the aneurysm.
On physical examination, the patient has normal pulses and expansive abdominal beat.
The rest of the examination was of no interest.
A baseline echocardiogram and respiratory function tests were performed within the preoperative aneurysm protocol, all of them without significant alterations.
We opted for a retroperitoneal approach with resection of the infrarenal aortic aneurysm and bypass graft with a 16-mm Hemazeld prosthesis, without intraoperative complications.
Neither lumbar nor polar arteries were visualized.
The postoperative course is normal, with no complications arising from the procedure, and the patient maintains adequate renal function.
At discharge he had all pulses.
The patient is asymptomatic in terms of vascular alteration; he preserves all pulses in the lower limbs, with preserved renal function parameters and control CT angiography, 6 months after the intervention, with no evidence of aneurism leakage.
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An intravenous urography was performed, which showed horseshoe kidney morphology and pyeloureteral junction in the anterior plane, with no significant changes in the collecting systems.
