ABDOMINAL AORTIC ANEURISM REPAIR IN PATIENTS WITH FUSED KIDNEY

Abstract

One of the factors determining the frequency of intra- and postoperative complications during operations on the abdominal part of the aorta is anatomical variations and abnormalities of renal arteries and veins. Among the renal structure anomalies the most common is a fused kidney. This anomaly is of great interest in patients with abdominal aortic aneurysm. The article highlights the historical aspects of the study of this group of patients, presents the classification, the features of surgical access, the advantages and disadvantages of each of them, the experience presented in the world literature, as well as the authors’ own experience in carrying out such operations for 30 years in the walls of the A.V. Vishnevsky National Medical Research Institute of Surgery. Peculiarities of surgical tactics in this group of patients were discussed: prevention of such complications as urinary leakage, addition of infection, bleeding, kidney ischemia and postoperative acute renal failure arising after routine intersection of the isthmus of the fused kidney, features in the placement of the prosthesis, data of CT, 3D reconstruction, CT-angiography, intraoperative photos were presented. The main issues that the surgeon faces during surgeries are considered: the choice of surgical access, the choice of the method of renal parenchyma protection, the choice of the method of reconstruction of the renal artery, the decision to preserve or intersect the isthmus of the fused kidney. The aspects of tactics definition in case of both planned and emergency operative interventions are considered. The authors also considered not only the possibility of performing open surgeries, but also X-ray endovascular operations, with a discussion of the advantages and disadvantages of each type of intervention.

Keywords

• подковообразная почка
• атеросклероз
• аневризма брюшного отдела аорты
• сосудистая хирургия
• эндоваскулярная хирургия