Renal Vascular Anatomic Abnormalities During Open Abdominal Aortic Repair

  • Domenico BaccellieriEmail author
  • Vincenzo Ardita
  • Gianbattista Tshiombo
  • Enrico Rinaldi
  • Yamume Tshomba
  • Roberto Chiesa


Renal arteries are defined as a pair of lateral branches from the abdominal aorta. Anatomical dissection studies have revealed that in most cases, each kidney receives one renal artery and one renal vein is deputized to drain blood into the inferior vena cava. The left renal vein also receives left suprarenal and left gonadal veins, in addition to the vein coming out from the kidney.

Supplementary material

Movie 5.1

A case of infrarenal abdominal aortic aneurysm associated with right inferior polar artery originating from the aneurysm. Perfusion of cold crystalloid into the orifices of the right inferior polar artery was performed, the aorto-aortic bypass reconstruction and direct reimplantation of the inferior polar artery to the graft has been performed. Post-operative CT scan shows the correct patency of the both renal arteries and right inferior polar artery (MOV 228597 kb)

Movie 5.2

Infrarenal abdominal aortic aneurysm associated to Horseshoe Kidney treated with aorto-aortic bypass reconstruction behind the kidney with direct reimplantation of the renal artery to the graft (MOV 1055 kb)


  1. 1.
    Glenn J. Analysis of 51 patients with horseshoe kidney. N Engl J Med. 1959;261:684–7.CrossRefGoogle Scholar
  2. 2.
    Sidell PM, Pairolero PC, Payne WS, Bernatz PE, Spittel JA Jr. Horseshoe kidney associated with surgery of the abdominal aorta. Mayo Clin Proc. 1979;54:97–103.PubMedGoogle Scholar
  3. 3.
    Bauer SB, Perlmutter AD, Retik AB. Anomalies of the upper urinary tract. In: Walsh PC, editor. Campbell’s urology. 6th ed. Philadelphia: WB Saunders; 1992. p. 1357–44.Google Scholar
  4. 4.
    O’Hara PJ, Hakaim AG, Hertzer NR, Herzer NR, Krajewski LP, Cox GS, et al. Surgical management of aortic aneurysm and coexistent horseshoe kidney: review of a 31 year experience. J Vasc Surg. 1993;17:940–7.CrossRefGoogle Scholar
  5. 5.
    Glodny B, Petersen J, Hofmann KJ, Schenk C, Herwig R, Treb T, et al. Kidney fusion anomalies revisited: clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney. BJU Int. 2009;103:224–35.CrossRefGoogle Scholar
  6. 6.
    Grainger R, Murphy DM, Lane V. Horseshoe kidney- a review of the presentation, associated congenital anomalies and complications in 73 patients. Ir Med J. 1983;76:315–7.PubMedGoogle Scholar
  7. 7.
    Faggioli GL, Freyrie A, Pilato A, Ferri M, Curti T, Paragona O, D’Addato M. Renal anomalies in aortic surgery: contemporary results. Surgery. 2003;133:641–6.CrossRefGoogle Scholar
  8. 8.
    Boujnh H, Abid I, Moalla N, Zmerli S. Le rein pelvien. Ann Urol. 1989;23:11–6.Google Scholar
  9. 9.
    Eisendrath DN, Phifer FM, Culver HB. Horseshoe kidney. Ann Surg. 1926;82:735–64.CrossRefGoogle Scholar
  10. 10.
    Phelan JT, Bernatz PE, DeWeerd JH. Abdominal aortic aneurysm associated with a horseshoe kidney: report of a case. Mayo Clin Proc. 1957;32:77–81.Google Scholar
  11. 11.
    Bietz DS, Merendno KA. Abdominal aneurysm and horse- shoe kidney: a review. Ann Surg. 1975;181:333–41.CrossRefGoogle Scholar
  12. 12.
    Brewster DC, Retana A, Waltman AC, Darling RC. Angiography in the management of aneurysms of the abdominal aorta: its value and safety. N Engl J Med. 1975;292:822–5.CrossRefGoogle Scholar
  13. 13.
    Connelly TL, McKinnon W, Smith RB III, Perdue GD. Abdominal aortic surgery and horseshoe kidney: report of six cases and a review. Arch Surg. 1980;115:1459–63.CrossRefGoogle Scholar
  14. 14.
    Shortell CK, Welch EL, Ouriel K, et al. Operative management of coexistent aortic disease and horseshoe kidney. Ann Vasc Surg. 1995;9:123–8.CrossRefGoogle Scholar
  15. 15.
    Canova G, Masini R, Santoro E, et al. Surgical treatment of abdominal aortic aneurysm in association with horseshoe kidney. Three case reports and a review of technique. Tex Heart Inst J. 1998;25:206–10.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Ilic NS, Koncar I, Dragas M, Cvetkovic S, Pejkic S, Kostic D, et al. Technical considerations for transabdominal aortic reconstruction with renal fusion and ectopia: case series. Vascular. 2010;18(5):269–74.CrossRefGoogle Scholar
  17. 17.
    Martin MC, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Schermerhorn ML. National outcomes after open repair of abdominal aortic aneurysms with visceral or renal bypass. Ann Vasc Surg. 2010;24(1):106–12.CrossRefGoogle Scholar
  18. 18.
    Greenberg RK, Lu Q, Roselli EE, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008;118:808–17.CrossRefGoogle Scholar
  19. 19.
    Chuter TA, Rapp JH, Hiramoto JS, Schneider DB, Howell B, Reilly LM. Endovascular treatment of thoracoabdominal aortic aneurysms. J Vasc Surg. 2008;47:6–16.CrossRefGoogle Scholar
  20. 20.
    Faggioli GL, Tarantini S, Stella A, D’Addato M. Aneurisma dell’ aorta addominale associato a rene ectopico pelvico e stenosi dell’ arteria renale. G It Chir Vasc. 1994;1:47–54.Google Scholar
  21. 21.
    Thompson GJ, Pace JM. Ectopic kidney: a review of 97 cases. Surg Gynecol Obstet. 1937;64:935.Google Scholar
  22. 22.
    Ezzet F, Dorazio R, Herzberg R. Horseshoe and pelvic kidneys associated with abdominal aortic aneurysms. Am J Surg. 1977;134:196–8.CrossRefGoogle Scholar
  23. 23.
    O’Hara PJ, Hakaim AG, Hertzer NR, Krajewski LP, Cox GS, Beven EG. Surgical management of aortic aneurysm and coexistent horseshoe kidney: review of 31-year experience. J Vasc Surg. 1993;17:940–7.CrossRefGoogle Scholar
  24. 24.
    Eckes D, Lawrence P. Bilateral iliac artery aneurysms and pancake kidney: a case report. J Vasc Surg. 1997;25:927–30.CrossRefGoogle Scholar
  25. 25.
    Hollis HW Jr, Rutherford R, Crawford GJ, Cleland BP, Marx WH, Clark JR. Abdominal aortic aneurysm repair in patients with pelvic kidney—technical considerations and literature review. J Vasc Surg. 1989;9:404–9.CrossRefGoogle Scholar
  26. 26.
    Schneider JR, Cronenwett JL. Temporary perfusion of congenital pelvic kidney during abdominal aortic aneurysm repair. J Vasc Surg. 1993;17:613–7.CrossRefGoogle Scholar
  27. 27.
    Lacombe M. Abdominal aortic aneurysmectomy in renal transplant patients. Ann Surg. 1986;203:62–8.CrossRefGoogle Scholar
  28. 28.
    Marone EM, Tshomba Y, Brioschi C, Calliari FM, Chiesa R. Aorto-iliac aneurysm associated with congenital pelvic kidney: a short series of successful open repairs under hypothermic selective renal perfusion. J Vasc Surg. 2008;47:638–44.CrossRefGoogle Scholar
  29. 29.
    Campbell DA Jr, Lorber MI, Arneson WA, Kirsh MM, Turcotte JG, Stanley JC. Renal transplant protection during abdominal aortic aneurysmectomy with a pump-oxygenator. Surgery. 1981;90:559–62.PubMedGoogle Scholar
  30. 30.
    Sterioff S, Parks L. Temporary vascular bypass for perfusion of a renal transplant during abdominal aneurysmectomy. Surgery. 1977;82:558–60.PubMedGoogle Scholar
  31. 31.
    Morales JP, Greenberg RK. Customised stent graft for complex thoraco-abdominal aneurysm associated with congenital pelvic kidney. Eur J Vasc Endovasc Surg. 2009;37:557–9.CrossRefGoogle Scholar
  32. 32.
    Spear R, Maurel B, Sobocinski J, Perini P, Guillou M, Midulla M, Azzaoui R, Tefera G, Haulon S. Technical note and results in the management of anatomical variants of renal vascularisation during endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2012;43(4):398–403.CrossRefGoogle Scholar
  33. 33.
    Aljabri B, McDonald PS, Satin R, Stein LS, Obrand DI, Steinmetz OK. Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Ann Vasc Surg. 2001;15:615–8.CrossRefGoogle Scholar
  34. 34.
    Minniti S, Procacci C. Congenital anomalies of the vena cava: embryological origin, imaging features and report of three new variants. Eur Radiol. 2002;12:2040–55.CrossRefGoogle Scholar
  35. 35.
    Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics. 2000;20:639–52.CrossRefGoogle Scholar
  36. 36.
    Giglia JS, Thompson JK. Repair of a thoracoabdominal aortic aneurysm in the presence of a left-sided inferior vena cava. J Vasc Surg. 2004;40:161–3.CrossRefGoogle Scholar
  37. 37.
    Karkos CD, Bruce IA, Thomson GJL, Lambert ME. Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg. 2001;15:703–8.CrossRefGoogle Scholar
  38. 38.
    Pilcher JM, Padhani AR. Problem in diagnostic imaging: behind the left renal vein. Clin Anat. 1997;10:349–52.CrossRefGoogle Scholar
  39. 39.
    Davis RA, Milloy FJ, Anson BJ. Lumbar, renal, and associated parietal and visceral veins based upon a study of 100 specimens. Surg Gynecol Obstet. 1958;107:1–22.PubMedGoogle Scholar
  40. 40.
    Brener BJ, Darling RC, Frederich PL, Linton RR. Major venous anomalies complicating abdominal aortic surgery. Arch Surg. 1974;108:159–65.CrossRefGoogle Scholar
  41. 41.
    Russell H, Samson MD, Michael R, Lepore MD Jr, David P, Showalter MD, Deepak G, Nair MD, Julien B, Lanoue S. Long-term safety of left renal vein division and ligation to expedite complex abdominal aortic surgery. J Vasc Surg. 2009;50:500–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Domenico Baccellieri
    • 1
    Email author
  • Vincenzo Ardita
    • 2
  • Gianbattista Tshiombo
    • 3
  • Enrico Rinaldi
    • 2
  • Yamume Tshomba
    • 4
    • 5
  • Roberto Chiesa
    • 6
  1. 1.Unit of Vascular SurgerySan Raffaele Scientific InstituteMilanItaly
  2. 2.Vascular Surgery UnitIRCCS San Raffaele Scientific InstituteMilanItaly
  3. 3.Vascular SurgeonFondazione CariploMilanItaly
  4. 4.Unit of Vascular SurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
  5. 5.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly
  6. 6.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly

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