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The coexistense of an abdominal aortic aneurysm with ectopic main renal vasculature complicates aortic surgery and mandates a focused imaging evaluation and a carefully planned operation to minimize renal ischemia. We present the case of a 75-year-old man with an abdominal aortic aneurysm and a right kidney with two ectopic main renal arteries, one originating from the aneurysmal distal aorta and the other from the right common iliac artery; the patient underwent a surgical repair and followed an uneventful course with no deterioration of renal function. The preoperative and intraoperative details are reported, along with a review of the literature.

Introduction: Abdominal aortic aneurysms (AAAs) are often incidental findings in patients undergoing US, CT or MRI studies. The recommended field of view (FOV) for standard CT examinations of the spine is 14 cm. This FOV does not allow full visualization of the abdominal aorta., Purpose: To justify a larger FOV for male smokers older than 55 years and women older than 65 years, with a higher incidence of AAA., Materials and Methods: The lumbar CT examinations of 100 consecutive patients (age: mean 68 years, range 55-85 years) presented with low-back pain were retrospectively reviewed. Measurements of the abdominal aorta and lumbar abnormalities were analysed. A control study in 850 patients who underwent abdominal CT scans for other causes was available for comparison., Results: There were three men with AAAs measuring 4.5, 5.5 and 5.6 cm (mean 5.2 cm). Findings related to the clinical problem were disk prolapse or herniation, spondylosis, spinal stenosis and grade I spondylolesthesis. In the control group, 17 patients were found with AAAs with diameter greater than 4 cm (2%)., Conclusions: Patients with low-back pain, older than 55 years of age, examined with lumbar spine CT, should also be screened for aortic disease, since the prevalence of AAA is similar with that of an age-matched control group. Appropriate modification in the applied FOV is recommended.

We describe three patients with abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS). These patients were treated by placement of an aortic endograft and angioplasty or stenting of the renal artery. After the procedure renal function improved or remained stable in two patients and deteriorated slightly in one. Blood pressure was reduced in one hypertensive patient and remained normal in the other two normotensive patients. In conclusion, simultaneous treatment of AAA and RAS with aortic endograft placement and renal artery angioplasty with or without stent, is a safe and effective technique for selected high-risk patients.

Introduction: Despite progress in the technical approach to aneurysms, inflammatory aortic aneurysms (IAA) in particular present the surgical team with a unique challenge. This retrospective study investigates immediate and late results after surgical treatment of IAA., Patients and Method: Fifteen cases of IAA among 520 aneurysmectomies of the abdominal aorta were operated during the period 1986-1995. All the patients were males of a mean age of 66 years. Diagnosis was established on preoperative CT-Scan, gross appearance at surgery and histologically. CT scanning could detect the IAA in 13 of 15 cases. In 2 cases MRI was diagnostic. Surgical treatment using the inlay method, constitutes the method of choice due to restricted dissection, as it reduces the possibility of iatrogenic injuries., Results: None of the patients died during the first 30 postoperative days. One patient died at the age of 78, 40 days after the operative procedure, due to a cerebral episode. Four to 120 months later 3 patients had also died from cause unrelated to the operation and one more patient was lost on follow-up. The remaining 10 patients were free of symptoms without any progression of the fibrotic process in the CT scanning. We observed a total regression in 7 and partial regression in 3 patients without detecting any inflammatory findings or renal failure., Conclusion: IAA's are rare. CT and/or MRI establish the diagnosis preoperatively and contribute to the surgical program with immediate and late results equal to those found in arteriosclerotic aneurysms of the abdominal aorta.

Objective: Ischemia of the spinal cord following procedures of the infrarenal abdominal aorta and the iliac arteries due to aneurysmatic or occlusive disease., Design: Retrospective study, duration of follow up: two years., Settings: Vascular Department of the 2nd Surgical Clinic of the University of Athens, Medical School., Patients: 1,112 operative procedures to the infrarenal abdominal aorta and iliac arteries, carried out from January 1, 1976 to June 30, 1994; 665 cases were aneurysms, electively operated, to which a tube graft was placed in 390 and a bifurcated graft in the remaining 265. Similarly 457 bifurcated prostheses were placed due to stenotic disease., Interventions: Aneurysmectomy, graft insertion., Measures: Death, severe disability., Results: Ischemic damage to the spinal cord was noted in two cases postoperatively. The first case following placement of bifurcated prosthesis due to high occlusion of the abdominal aorta and the second case following resection of an aneurysm and placement of a tube graft. One of the patients passed away on the 43rd postoperative day, and the other 18 months after was able to stand but, however, could not walk easily without the help of another person., Conclusions: The complication seems to be multicausal, carrying a bad prognosis and cannot be foreseen. The stable hemodynamic condition of the patient during the operative and postoperative period with revascularisation of at least one hypogastric artery, reduces the time of aortic occlusion and securing collateral circulation might reduce these complications. Also preopeorative angiography of the spinal cord with more sophisticated techniques, might constitute the most reliable prognosis in the future.

The surgical tactics in cases of aneurysm of the infrarenal abdominal aorta and a second intraperitoneal operative procedure are not uniform in the literature and still remain a matter of debate. In 170 aneurysms of the abdominal aorta there were 18/170 (10.5%) other co-existent surgical non-vascular diseases as follows: Thirteen cases with symptomatic or asymptomatic cholecystopathy, one case with abdominal hernia, three cases with Ca of the colon and one case with Ca of the liver. In 9 cases, the aneurysm and the gallbladder were removed concomitantly, in 3 cases only aneurysmectomy was carried out due to cardiopulmonary problems, of which in two cholecystectomy was carried out in a second stage. In one case with cholecystitis, the gallbladder was removed and aneurysmectomy followed one month after. Aneurysmectomy and sigmoidectomy were carried out in one case and in a second similar case sigmoidectomy preceded followed by aneurysmectomy 6 months later. In one case aneurysmectomy and restoration of the abdominal hernia was performed concomitantly, while two more cases, one with liver lobectomy and another with orthosigmoidectomy due to Ca. No one of the above patients presented with any infection of the graft or other postoperative complication. No other complications were noted during a follow-up period of 19 months. The one stage operation management of infrarenal abdominal aortic aneurysm and a second (intra-abdominal) surgical procedure is feasible if appropriate care is given to the technical details and due consideration to the rules of antisepsis, without affecting surgical morbidity and mortality of the patient.