Endovascular inframesenteric aortic aneurysm repair in cross fused renal ectopia

Abstract

Background: Renal ectopy is a congenital anomaly that arises from the disruption of normal renal embryologic migration. Crossed fused renal ectopia (CFRE) occurs when the ectopic kidney crosses midline and fuses with the contralateral kidney. Blood supply can be variable, and can come from the aorta, iliac, or even hypogastric arteries. Careful consideration of blood supply and operative approach is warranted when considering an endovascular approach to abdominal aortic aneurysm (AAA) repair of these patients. Methods: We present a case of a 72-year-old female who presented with abdominal and back pain. An inframesenteric AAA was found measuring 5.4 cm with CFRE supplied by a single right renal artery arising from the left common iliac artery. The right common iliac artery arose superior to the distal aorta just distal to the aneurysmal sac. Results: An endovascular aortic aneurysm repair was completed with a stent graft placed just distal to the takeoff of the superior mesenteric artery, with a left iliac limb placed just proximal to the right renal artery takeoff. The patient did well post-operatively and was discharged by post-operative day 2. CTA Aorta post-operatively showed widely patent endovascular stent grafts without evidence of an endoleak. The CFRE with right renal artery arising from the left common iliac artery was also widely patent. Conclusions: Renal ectopy is a congenital anomaly of the kidney and urinary tract, and can present with different vascular configurations. In the setting of a AAA amenable to EVAR, careful preoperative planning can facilitate a successful repair.