ABDOMINAL AORTIC ANEURISM REPAIR IN PATIENTS WITH FUSED KIDNEY
https://doi.org/10.21518/2307-1109-2019-2-103-114
Abstract
One of the factors determining the frequency of intra- and postoperative complications during operations on the abdominal part of the aorta is anatomical variations and abnormalities of renal arteries and veins. Among the renal structure anomalies the most common is a fused kidney. This anomaly is of great interest in patients with abdominal aortic aneurysm. The article highlights the historical aspects of the study of this group of patients, presents the classification, the features of surgical access, the advantages and disadvantages of each of them, the experience presented in the world literature, as well as the authors’ own experience in carrying out such operations for 30 years in the walls of the A.V. Vishnevsky National Medical Research Institute of Surgery. Peculiarities of surgical tactics in this group of patients were discussed: prevention of such complications as urinary leakage, addition of infection, bleeding, kidney ischemia and postoperative acute renal failure arising after routine intersection of the isthmus of the fused kidney, features in the placement of the prosthesis, data of CT, 3D reconstruction, CT-angiography, intraoperative photos were presented. The main issues that the surgeon faces during surgeries are considered: the choice of surgical access, the choice of the method of renal parenchyma protection, the choice of the method of reconstruction of the renal artery, the decision to preserve or intersect the isthmus of the fused kidney. The aspects of tactics definition in case of both planned and emergency operative interventions are considered. The authors also considered not only the possibility of performing open surgeries, but also X-ray endovascular operations, with a discussion of the advantages and disadvantages of each type of intervention.
About the Authors
A. E. Zotikov
Federal State Budgetary Institution «A.V. Vishnevsky National Medical Research Institute of Surgery» of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Corr. Member of RAS, Dr. of Sci. (Med.), Professor, Leading Researcher, Surgeon of the Vascular Surgery Department
27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia
V. N. Gontarenko
Federal State Budgetary Institution «A.V. Vishnevsky National Medical Research Institute of Surgery» of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Cardiovascular Surgeon, Researcher of the Department of Vascular Surgery
27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia
A. S. Ivandayev
Moscow State Budgetary Healthcare Institution «M. Konchalovskiy City Clinical Hospital» of the Department of Healthcare of Moscow
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Cardiovascular Surgeon of the Department of Vascular Surgery
2/1, Kashtanovaya alleya, Zelenograd 124489, Russia
V. N. Tsygankov
Dolgoprudny Central City Hospital
Russian Federation
Russian Federation
Dr. of Sci. (Med.), Mini-invasive Vascular Surgeon at the Dolgoprudny Central City Hospital
2, Pavlova Str., Dolgoprudny, Moscow Region, 141704, Russia
A. S. Kutovaya
Federal State Budgetary Institution «A.V. Vishnevsky National Medical Research Institute of Surgery» of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Resident Physician, Vascular Surgery Department
27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia
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Review
For citations:
Zotikov A.E., Gontarenko V.N., Ivandayev A.S., Tsygankov V.N., Kutovaya A.S. ABDOMINAL AORTIC ANEURISM REPAIR IN PATIENTS WITH FUSED KIDNEY. Aterotromboz = Atherothrombosis. 2019;(2):103-114. (In Russ.) https://doi.org/10.21518/2307-1109-2019-2-103-114
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