Intraoperative surprise in a patient with aorto-iliac occlusive disease: Horseshoe kidney

摘要

A 65-year-old male presented with rest pain for 2 weeks in the right lower extremity and he had ischemic wound in the distal part of first phalanx of right foot. He had controlled hypertension and hyperlipidemia for 10 years. There were no abnormalities in routine blood tests and hemodynamic parameters. No pulse was palpable in both lower extremities. Preoperative investigations revealed ankle-brachial index of 0.57 on the right and 0.73 on the left. Also, we determined poikilothermia (cold) in lower extremities. The case was assessed as critical limb ischemia (CLI). Bilateral lower extremity angiogram was performed according to 2016 AHA/ACC Guideline ; it showed that right common iliac artery was completely occluded and there was 70–90% lesion in the left external iliac artery ( ). Preoperative angiographic evaluation using the Trans-Atlantic Inter-Society Consensus (TASC II) classification showed our case in class TASC-II C lesion. Therefore, Aorto-bifemoral bypass was planned for the patient.