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(A): computed tomography showing the huge aneurysm associated to Horse-Shoe-Kidney.. Black arrow: the isthmus.. (B): coronal view showing the angulated neck of the inferior renal aorta.
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Computed tomography (CT) revealed a 11.2 cm infrarenal AAA associated to a HSK with a wide parenchymatous isthmus lying anterior to the aneurysm (Fig. 1A, B).
Per operative view showing the aneurysm with a wide parenchymatous isthmus lying anterior to the aneurysm.. Black arrow: aneurysm.
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We couldn't recognise the limits between the ishtmus and the renal parenchyma so we decided to avoid isthmus section and its related complications (Fig. 2).
Y-shaped Dacron graft (16-8 mm) placed under the isthmus.
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After systemic heparinisation and clamping, the aneurismal sac was longitudnally opened; thrombus was removed and lumbar arteries were sutured, then a Y-shaped Dacron graft (16-8 mm) was placed under the isthmus for the reconstruction (Fig. 3).