Endovascular repair of an abdominal aortic aneurysm in a patient with horseshoe kidney demonstrating the nonend artery nature of an accessory isthmic artery

Horseshoe kidney is a rare congenital anomaly of the urinary system and a coexisting abdominal aortic aneurysm with a horseshoe kidney is associated with substantial surgical challenges. The horseshoe kidney has a variant arterial supply in the majority of patients with accessory renal arteries arising from the aorta or iliac arteries. These arteries are considered to be end arteries and renal tissue perfused with these vessels is under risk of infarction in case of compromise. Since the surgical approach is challenging and carries a high risk of complications, endovascular repair seems to be an attractive alternative when feasible. The purpose of this report is to describe our experience in the successful endovascular treatment of a patient who had the coexistence of an abdominal aortic aneurysm with a horseshoe kidney. The patient had an accessory isthmic artery which shared a common origin with the middle sacral artery which provided retrograde flow following stent-grafting. There was no loss of renal tissue following the intervention. This case demonstrates that accessory renal arteries in patients with horseshoe kidneys are not necessarily end arteries. Their careful analysis prior to the procedure is essential for rational therapy planning.