Surgical treatment of abdominal aortic aneurysm with solitary pelvic kidney

Introduction: pelvic kidney is an anatomical variant with minimal incidence in the general population; its association with abdominal aortic aneurysm (AAA) is even more infrequent. Case report: a 69-year-old man with stage 4 renal failure, was referred due to an ultrasound finding of AAA. CT angiography shows a 56-mm AAA with a single pelvic kidney whose single renal artery arises from the aortic bifurcation. The patient underwent elective surgical treatment. An aortobiiliac bypass and a bypass from the right branch of the graft to the renal artery with inverted great saphenous vein (GSV) were performed. The renal protection techniques consist on administrating intravenous mannitol prior to renal clamping and to perform the anastomosis of the GSV with the renal artery in first place in order to infuse cold saline solution during the time of ischemia. The postoperative period was uneventful except for a slight deterioration in renal function that was resolved with medical treatment. Discussion: the presence of a pelvic kidney in the treatment of aneurysmal aortic pathology can be challenging. On the one hand, it represents a limitation to endovascular techniques and on the other hand, the need to minimize the time of renal ischemia during clamping can significantly increase the complexity of the surgical treatment.