Open repair of an abdominal aortic aneurysm in a patient with congenital renal vascular anomalies

Purpose: The renal vasculature is unique in such a way that each artery behaves as an end artery. The amount of renal damage that can occur by sacrificing these arteries are so unpredictable. The presence of aberrant or accessory renal arteries makes open repair of the abdominal aortic aneurysm (AAA) technically more challenging than conventional surgery. Here, we describe various techniques used to preserve the renal vasculature and prevent renal ischemia during surgery. Methods: We present a case of saccular AAA with low lying right kidney with an aberrant renal artery arising from neck and an accessory renal artery arising from the body of the aneurysm. We performed an open repair of the aneurysm, during which we did inter-renal clamping and renal perfusion with renoplegia solution using Pruitt-Inahara shunt. Conclusions: Interrenal clamping and administration of optimal renoplegia solution through shunt are very useful adjuncts to prevent renal ischemia during open repair of AAA with congenital renal vascular anomalies. Pruitt-Inahara Shunt, classically described in carotid endarterectomy, can be used in AAA surgeries for administering renoplegia