Horseshoe kidney (HSK) is the most common congenital abnormality of the urologic system encountered during abdominal aortic aneurysm (AAA) surgery. Here, the authors report a case of AAA coexisting with HSK that was successfully treated by open surgery. Two accessory renal arteries of 2.5 mm and 3.1 mm were reimplanted. One of the implanted arteries later occluded and infarct of the isthmus developed, but there was no impairment of renal function. The authors discuss the complexity of the surgical treatment of AAA coexisting with HSK, and place focus on which accessory renal arteries should be reconstructed.
Aortic Aneurysm, Abdominal* ; Arteries ; Congenital Abnormalities ; Kidney* ; Renal Artery

BACKGROUNDSome individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). This study reported the application of color Doppler sonography (CDS) in the detection of severe stenosis in one of the multiple arteries.

METHODSPatients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities (PSV) of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography (DSA).

RESULTSFour children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis > 70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns.

CONCLUSIONNon-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in young patients.

Adolescent ; Child ; Female ; Humans ; Male ; Renal Artery ; abnormalities ; Renal Artery Obstruction ; diagnostic imaging ; Ultrasonography, Doppler, Color ; methods

OBJECTIVETo improve the operative procedure of the left renal vein nutcracker syndrome.

METHODSTwo patients underwent transposition of the left renal vein in the treatment of the left renal vein nutcracker syndrome.

RESULTRenal ischemia, due to clamping of the renal artery, lasted 14 minutes and 13 minutes, respectively. The gross hematuria disappeared 1 day and 4 days respectively after surgery, and microhematuria ceased spontaneously 5 days and 7 days respectively after surgery. Transposition of the left renal vein effectively relieved the symptoms related to the left renal vein nutcracker syndrome. The patients had no recurrence of symptoms following up during 3 months.

CONCLUSIONTransposition of the left renal vein is a safe and effective surgical approach in the treatment of the left renal vein nutcracker syndrome.

Adult ; Constriction, Pathologic ; Hematuria ; prevention & control ; Humans ; Male ; Mesenteric Artery, Superior ; abnormalities ; Renal Veins ; surgery ; Syndrome

Only rarely is renal cell carcinoma encountered in a horseshoe kidney. This is a case report on renal cell carcinoma in a horseshoe kidney, in which superselective renal artery embolization was performed preoperatively. CT and digital subtraction angiography revealed a horseshoe kidney with a 3-cm tumor in the left side. Superselective renal artery embolization of the tumor was performed as a prerequisite procedure for the organ-preserving surgery of simple enucleation. Preoperative superselective renal artery embolization can be an effective tool to facilitate organ-preserving surgery in a horseshoe kidney.
*Renal Artery ; Middle Aged ; Male ; Kidney Neoplasms/complications/*therapy ; Kidney/*abnormalities ; Humans ; *Embolization, Therapeutic ; Carcinoma, Renal Cell/complications/*therapy ; Abnormalities/therapy

The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Renal Artery/abnormalities/anatomy & histology/*radiography ; Renal Veins/abnormalities/anatomy & histology/*radiography ; Tomography, X-Ray Computed/*methods ; Young Adult

Williams syndrome is a congenital disorder characterized by mental retardation, loquacious personalities, dysmorphic face, and vascular and valvular abnormalities. The etiology of this syndrome was one allelic loss of elastin gene, exhibiting a submicroscopic deletion, at 7q11.23. Sudden death is an infrequently recognized complication. The mechanism of sudden death is explained by myocardial ischemia, decreased cardiac output, and arrhythmia by anatomical abnormality of coronary artery stenosis and severe biventricular outflow tract obstruction. We report an autopsy case of a 80 day-old male with Williams syndrome. Five days before admission, cardiac murmur was detected incidentally on ascultation at a local clinic during a visit for vaccination. He was transferred to our hospital and cardiac catheterization was done. He died suddenly next day. Postmortem examination revealed a dysmorphic face and multiple cardiovascular abnormalities including supravalvular aortic stenosis with narrowed coronary artery ostia, supravalvular pulmonic stenosis, secundum type of atrial septal defect, right ventricular hypertrophy, and renal artery stenosis. Histologically, aorta and pulmonary, bronchial, and renal arteries showed markedly hyperplastic medial elastic laminae approximately three times thick compared to those of age-matched normal artery. The elastic fibers of the innermost two thirds of media were disposed in a normal orderly parallel fashion. In outer third of the media, the elastic fibers had lost the normal orderly arrangement.
Aorta ; Aortic Stenosis, Supravalvular ; Arrhythmias, Cardiac ; Arteries ; Autopsy* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Cardiovascular Abnormalities ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Coronary Stenosis ; Coronary Vessels ; Death, Sudden ; Elastic Tissue ; Elastin ; Heart Murmurs ; Heart Septal Defects, Atrial ; Humans ; Hypertrophy, Right Ventricular ; Infant* ; Intellectual Disability ; Loss of Heterozygosity ; Male ; Myocardial Ischemia ; Pulmonary Valve Stenosis ; Renal Artery ; Renal Artery Obstruction ; Vaccination ; Williams Syndrome*

Williams syndrome is a congenital disorder characterized by mental retardation, loquacious personalities, dysmorphic face, and vascular and valvular abnormalities. The etiology of this syndrome was one allelic loss of elastin gene, exhibiting a submicroscopic deletion, at 7q11.23. Sudden death is an infrequently recognized complication. The mechanism of sudden death is explained by myocardial ischemia, decreased cardiac output, and arrhythmia by anatomical abnormality of coronary artery stenosis and severe biventricular outflow tract obstruction. We report an autopsy case of a 80 day-old male with Williams syndrome. Five days before admission, cardiac murmur was detected incidentally on ascultation at a local clinic during a visit for vaccination. He was transferred to our hospital and cardiac catheterization was done. He died suddenly next day. Postmortem examination revealed a dysmorphic face and multiple cardiovascular abnormalities including supravalvular aortic stenosis with narrowed coronary artery ostia, supravalvular pulmonic stenosis, secundum type of atrial septal defect, right ventricular hypertrophy, and renal artery stenosis. Histologically, aorta and pulmonary, bronchial, and renal arteries showed markedly hyperplastic medial elastic laminae approximately three times thick compared to those of age-matched normal artery. The elastic fibers of the innermost two thirds of media were disposed in a normal orderly parallel fashion. In outer third of the media, the elastic fibers had lost the normal orderly arrangement.
Aorta ; Aortic Stenosis, Supravalvular ; Arrhythmias, Cardiac ; Arteries ; Autopsy* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Cardiovascular Abnormalities ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Coronary Stenosis ; Coronary Vessels ; Death, Sudden ; Elastic Tissue ; Elastin ; Heart Murmurs ; Heart Septal Defects, Atrial ; Humans ; Hypertrophy, Right Ventricular ; Infant* ; Intellectual Disability ; Loss of Heterozygosity ; Male ; Myocardial Ischemia ; Pulmonary Valve Stenosis ; Renal Artery ; Renal Artery Obstruction ; Vaccination ; Williams Syndrome*

Ureteropelvic junction obstruction is usually intrinsic and is most common in children. Aberrant renal arteries are present in about 30% of individuals. Aberrant renal arteries to the inferior pole cross anteriorly to the ureter and may cause hydronephrosis. To the best of our knowledge, although there are some papers about aberrant renal arteries producing ureteropelvic junction obstruction, there is no report of a case which is diagnosed by the new modalities, such as computed tomography angiogram (CTA) or magnetic resonance angiogram (MRA). We describe a 36-year-old woman with right hydronephrosis. Kidney ultrasonogram and excretory urogram revealed right hydronephrosis. CTA and MRA clearly displayed an aberrant renal artery and hydronephrosis. The patient underwent surgical exploration. For the evaluation of hydronephrosis by an aberrant renal artery, use of CTA and MRA is advocated.
Adult ; Female ; Flank Pain/diagnosis/etiology ; Follow-Up Studies ; Humans ; Hydronephrosis/*diagnosis/etiology/surgery ; Magnetic Resonance Angiography/methods ; Renal Artery/*abnormalities/radiography ; Risk Assessment ; Tomography, X-Ray Computed ; Treatment Outcome ; Ureteral Obstruction/*complications/radiography/surgery ; Urography/methods ; Urologic Surgical Procedures/methods

OBJECTIVE: To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. MATERIALS AND METHODS: This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. RESULTS: The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. CONCLUSION: Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.
Adult ; Aged ; Angiomyolipoma/therapy ; Arteriovenous Malformations/therapy ; Child ; Embolization, Therapeutic/adverse effects/*methods ; Female ; Graft Rejection/therapy ; Hematuria/etiology ; Humans ; Infarction/etiology ; Kidney/blood supply ; Kidney Diseases/surgery/*therapy ; Kidney Failure, Chronic/therapy ; Kidney Neoplasms/therapy ; Male ; Middle Aged ; Nephrectomy/adverse effects/*methods ; *Renal Artery/abnormalities ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the diagnosis, treatment and surgical outcomes of ureteropelvic junction obstruction (UPJO) caused by renal crossing vessels.

METHODSThe case records of 24 patients discharged from Peking University Third Hospital between June 2001 and September 2011 with the diagnosis of UPJO caused by renal crossing vessels were reviewed .Of the 24 patients, 17 were male and 7 were female patients. The mean age was 28 years (range, 2-63 years). The mean disease duration was 22.3 months (range, 7 days to 180 months). Of which, 4 patients underwent open surgery, and the other 20 patients were treated with laparoscopic surgery. Surgical approach was decided by operative conditions: adhesion release technique, dismembered pyeloplasty or Y-V anastomosisor, with or without cut off the crossing vessels. The kind of crossing vessels was recorded, and the effect of surgery was evaluated by follow-up.

RESULTSFifteen cases were caused by oppressed renal crossing artery, 8 cases by renal crossing vein, and 1 case by 2 renal crossing arteries and 1 renal crossing vein. Among them, 11 cases were followed up successfully. Average follow-up time was 48.2 months (range, 13-120 months). Eight cases (8/11) were relieved, and 1 case (1/11) had no obvious improvement, another 2 cases (2/11) were aggravating. Among those 6 cases underwent adhesion release technique, 3 cases were relieved, 1 case had no obvious improvement, and 2 cases were aggravating. Five cases who underwent dismembered pyeloplasty was relieved significantly.

CONCLUSIONSRenal crossing artery is one of the main causes of UPJO, the crossing artery should be retained as far as possible. Crossing vessel oppression is not the only pathological cause of UPJO, so the treatment of UPJ constriction is also very important. Dismembered pyeloplasty seems to be the most efficacies treatment procedure for UPJO caused by repressed vessels, and the remission rate of adhesion release technique seems limited.

Adolescent ; Adult ; Arteries ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Hydronephrosis ; congenital ; etiology ; surgery ; Kidney ; blood supply ; Kidney Pelvis ; blood supply ; Laparoscopy ; methods ; Male ; Middle Aged ; Multicystic Dysplastic Kidney ; etiology ; surgery ; Renal Artery ; abnormalities ; Treatment Outcome ; Ureteral Obstruction ; etiology ; surgery ; Young Adult