Milanko Maksic^1,2, Momir Bobar²*, Jelena Inđić Četić², Stefan Dučić^3,4 and Lazar B Davidovic^3,4

¹Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina
²Clinic for Vascular Surgery, Clinical Center of Republic of Srpska, Bosnia and Herzegovina
³Faculty of Medicine, University of Belgrade, Serbia
⁴Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Serbia

*Corresponding Author: Momir Bobar, Clinic for Vascular Surgery, Clinical Center of Republic of Srpska, Bosnia and Herzegovina.

Received: December 01, 2025; Published: December 31, 2025

Abstract

The co-existence of abdominal aortic aneurysm (AAA) and horseshoe kidney (HK) is rare. However, horseshoe kidney limits access to the abdominal aorta during open surgery.

This is a retrospective single-center study which includes four patients with horseshoe kidney who underwent open surgery of the abdominal aorta in the Department of vascular surgery, Clinical Center of the Republic of Srpska between 2020 and 2025. Three patients had abdominal aortic aneurysm, while one had aortoiliac occlusive disease. According to Crawford classification, all patients had type II of horseshoe kidney vascularization (two normal and 1-3 anomalous renal arteries originating from infrarenal aorta or from iliac arteries).

In all cases midline laparotomy incision was used, while renal isthmus was preserved. In three cases that required aortic cross clamping above the anomalous renal arteries, renal protection was used. All significant anomalous renal arteries (diameter larger than 3mm) were preserved. There were no cases of renal failure and mortality during the first 30 postoperative days, as well as after the mean follow-up period of 30.75 months.

In majority of cases open surgery is the first choice for the treatment of abdominal aortic diseases in the presence of horseshoe kidney. It requires careful planning of operative strategy, including exact preoperative identification of HK vascularization and collecting systems anatomy. We recommend the midline laparotomy approach and preservation of the renal isthmus and all significant renal arteries. EVAR can be used selectively if patients with associated horseshoe kidney have suitable anatomy.

 Keywords: Open Surgery; Horseshoe Kidney; Case Series; Midline Laparotomy

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Citation

Citation: Momir Bobar., et al. “Case Series of Abdominal Aortic Open Surgery in the Presence of Horseshoe Kidney”.Acta Scientific Medical Sciences 10.1 (2026): 72-79.

Copyright

Copyright: © 2026 Momir Bobar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.