Recently, the vascular surgery team successfully performed an endovascular aortic repair procedure for a middle-aged male patient with high-risk type B thoracic aortic dissection complicated by a rare “horseshoe kidney” malformation. The success of this surgery marks a new milestone in the comprehensive technical capabilities of the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU) in managing complex and high-risk vascular diseases.
Type B thoracic aortic dissection is a critical and life-threatening emergency in cardiovascular medicine. It occurs when a tear forms in the aortic wall, allowing blood to surge into the dissected channel; once rupture develops, the mortality rate is extremely high, making the condition exceptionally dangerous. What made this case even more distinctive and challenging was the patient’s concomitant congenital horseshoe kidney anomaly, in which the bilateral kidneys are fused at a very low position in the body, forming a U-shaped structure. This unique anatomical structure causes the abnormally large and complex renal feeding arteries to directly originate from the critical area affected by the abdominal aortic aneurysm or dissection, which undoubtedly posed a significant obstacle to the design and implementation of the surgical plan. During the procedure, the team not only had to precisely exclude the dissection entry tear but also had to ensure absolute patency of the bilateral arteries supplying the horseshoe kidney; any lapse could have led to renal ischemia and necrosis, with the technical difficulty and risk increasing geometrically.
In response to this challenge, the discipline team’s preoperative team conducted meticulous three-dimensional imaging assessment and developed a comprehensive procedural plan. During the procedure, under precise DSA guidance, Professor Yang Lin’s team deployed the covered stent in the predetermined position with “precision bomb-disposal” accuracy, successfully sealing the intimal tear and reconstructing a healthy blood-flow channel. Postoperative angiography showed complete exclusion of the aortic dissection, while all vessels supplying the horseshoe kidney remained patent with adequate blood flow, marking a successful outcome. The patient is currently recovering well and has been discharged.
The successful completion of this procedure demonstrates the strong collaborative capability and individualized, precision treatment expertise of the Department of Vascular Surgery in managing high-risk cases involving multi-system comorbidities and abnormal anatomy, providing solid guarantee for the life and health of patients with complex conditions.
