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Gembillo G, Bellinghieri G, Savica V, Santoro D. Horseshoe Kidney: 500 Years From the First Report in the Literature. EXP CLIN TRANSPLANT 2023; 21:49-52. [PMID: 37496344 DOI: 10.6002/ect.iahncongress.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Horseshoe kidney or ren arcuatus is the most common renal fusion anomaly, with an incidence of 1:500 in the normal population and a male predominance of 2:1. In >90% of cases, the fusion occurs along the inferior pole. It may vary in location, orientation, and arterial and venous anatomy. In 1522, Berengario da Carpi described this renal malformation for the first time in his masterpiece "Isagogae breves" (Introduction to Anatomy). He reported the results of a postmortem examination in the public autopsy room of the University of Bologna, describing "kidneys that are continuous as if they were a kidney, with two emulsifying veins, two emulsifying arteries, two ureteral outlets." In 1564, Leonardo Botallo described and illustrated the features of this atypical anatomical representation, and later, in 1602, Leonard Doldius added further details by examining this anatomical feature during an autopsy. In 1761, Giovanni Battista Morgagni discussed this condition not only as a rare anatomical curiosity found only in necroscopy but also discussed its physiological aspect. In the nineteenth century, with the advent of renal surgery, the horseshoe kidney played a more important role in urological diagnosis and treatment, and its identification became more frequent. With the advent of pyelography, imaging reports of the horseshoe kidney allowed a more accurate representation of the anatomical variants, which was particularly useful in preoperative assessment and outcomes. Berengario da Carpi laid the foundation for a better knowledge of this anatomical anomaly. Five hundred years after the first report in the literature, relevant advances have been made in the management of complications associated with horseshoe kidney and in diagnosis, confirming the need to monitor individuals with this condition who are at higher risk of developing chronic kidney disease.
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Affiliation(s)
- Guido Gembillo
- From the Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Handa K, Sakamoto T, Kakizawa Y, Kitahara M, Fukui S, Shirakawa Y, Nishi H. Endovascular Aneurysm Repair for a Patient with Horseshoe Kidney and the Importance of Watershed Sign and Volumetry by Preoperative Contrast-Enhanced Computed Tomography. Ann Vasc Dis 2021; 14:396-399. [PMID: 35082949 PMCID: PMC8752936 DOI: 10.3400/avd.cr.21-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022] Open
Abstract
We report a case of endovascular aneurysm repair (EVAR) in a patient with horseshoe kidney (HSK) in whom preoperative contrast-enhanced (CE) computed tomography (CT) showed watershed sign. This sign enabled prediction of postoperative renal function by accurate renal volumetry. A 75-year-old man with HSK and a 59-mm abdominal aortic aneurysm was referred for treatment. Preoperative CECT showed watershed lines at the margin of the isthmus, which was perfused by the accessory renal arteries. Using this sign, we calculated the accurate volume of the isthmus, which was 24.5% of the total parenchyma. EVAR was safely performed without renal dysfunction.
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Yumi Kakizawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Shinya Fukui
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
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Bounssir A, Bakkali T, Taghi H, Sefiani Y, Lekehal B. Best strategy in managing the association of Horse-shoe-Kidney and Abdominal Aortic Aneurysm: Case report. Int J Surg Case Rep 2020; 75:11-15. [PMID: 32898841 PMCID: PMC7481754 DOI: 10.1016/j.ijscr.2020.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 11/26/2022] Open
Abstract
Most common renal anomalies. Rare association of Horse-Shoe-kidney and Abdominal aortic aneurysm. Special challenge in managing this pathology given the close spatial relationship. Frequent renal arterial variation. Surgery or endovascular treatment.
Introduction Horseshoe Kidney (HSK) is probably the most common of all renal fusion abnormalities. However the association of Abdominal aortic aneurism (AAA) and HSK is rare, and occurred in 0,12% of patient affected by AAA. Presentation of case We present a patient with the concomitant presence of AAA and HSK treated by open surgical repair with a transperitoneal approach without section of the isthmus with great outcomes after surgery. Discussion The management of AAA associated with HSK presents a special challenge during vascular surgery, given the close spatial relationship and the frequent renal arterial variations that accompanies HSK. Conclusion Diagnosis and a well designed surgical strategy are required to avoid surgical post operative complications.
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Affiliation(s)
- Ayoub Bounssir
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco.
| | - Tarik Bakkali
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
| | - Houda Taghi
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
| | - Yasser Sefiani
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
| | - Brahim Lekehal
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
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Majos M, Majos A, Polguj M, Szymczyk K, Chrostowski J, Stefańczyk L. Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study. J Clin Med 2019; 8:jcm8040464. [PMID: 30959826 PMCID: PMC6518850 DOI: 10.3390/jcm8040464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background: The most common renal fusion anomaly is horseshoe kidney (HSK), a condition associated with variable arterial blood supply. The aim of this study was to determine whether the height of origin of the renal artery determines its diameter and whether it differs from the mean diameter of the renal arteries of normal kidneys (NK). Methods: Computer tomography angiography (CTA) studies of 336 patients (88 HSK and 248 NK) were obtained in a search of renal arteries; these were than classified into four groups according to height of its origin: Group I, branching from the aorta superior to the inferior mesenteric artery (IMA); Group II, branching from the aorta below the IMA; Group III, branching from the iliac artery; and Group IV, originating from the internal and external iliac artery. Results: The HSK group included 398 arteries (mean diameter 4.30 mm) and the NK group 598 (5.52 mm) (p < 0.0001). In the HSK group, the mean diameters according to groups were: Group I, 4.54 mm; Group II, 4.28 mm; Group III, 3.41 mm; and Group IV, 3.43 mm. Statistically significant differences were found between arteries originating from the aorta and arteries branching from the iliac arteries (p < 0.0001). In the NK group, the corresponding values were: Group I, 5.53 mm; and Group II, 4.45 mm. The number of arteries supplying the HSK wider than 3.0 mm were: Group I, 83.0%; Group II, 82.4%; Group III, 68.4%; and Group IV, 66.6%. Conclusions: The renal arteries of the HSK branch from their parental vessels at lower levels and have smaller diameters than those of NK.
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Affiliation(s)
- Marcin Majos
- Department of Radiology, Barlicki University Hospital, Medical University of Łódź, Kopcińskiego Str. 22, 90-153 Łódź, Poland.
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, ul. Pomorska 251, 92-213 Łódź, Poland.
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Łódź, Żeligowskiego 7/9, 90-752 Łódź, Poland.
| | - Konrad Szymczyk
- Department of Radiology, Barlicki University Hospital, Medical University of Łódź, Kopcińskiego Str. 22, 90-153 Łódź, Poland.
| | - Jakub Chrostowski
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, ul. Pomorska 251, 92-213 Łódź, Poland.
| | - Ludomir Stefańczyk
- Department of Radiology, Barlicki University Hospital, Medical University of Łódź, Kopcińskiego Str. 22, 90-153 Łódź, Poland.
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Castaneda K, Puckett Y, Leal A, Ronaghan CA. Deployment of a Resuscitative Endovascular Balloon Occlusion of the Aorta Device in a Case of Gunshot Wound Injury to a Horseshoe Kidney. Cureus 2018; 10:e3399. [PMID: 30533333 PMCID: PMC6279008 DOI: 10.7759/cureus.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A horseshoe kidney (HSK) is a urological malformation that is typically found incidentally after a traumatic injury due to its asymptomatic nature. We present a 25-year-old male with multiorgan injuries secondary to blunt abdominal trauma caused by a gunshot wound. We report the courses of action taken that led to the identification of the HSK and other associated intra-abdominal injuries and the subsequent surgical management. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an improving minimally invasive technique that was used to control hemorrhage in the early preoperative stages and during surgical repair of the injuries. Multiorgan injuries that involve an HSK are uncommon. Our interest in the case relies on the rarity and unique aspects of the injuries and the recovery of the patient following the use of REBOA.
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Affiliation(s)
- Karen Castaneda
- Miscellaneous, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Yana Puckett
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Andres Leal
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
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Kfoury E, Almanfi A, Dougherty KG, Krajcer Z. Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia. Tex Heart Inst J 2016; 43:232-5. [PMID: 27303239 DOI: 10.14503/thij-15-5025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature.
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Guvendi B, Ogul H. Left Renal Vein Compression and Horseshoe Kidney: An Extraordinary Association. Med Princ Pract 2016; 25:494-6. [PMID: 27304675 PMCID: PMC5588555 DOI: 10.1159/000447594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/14/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Our aim was to report the importance of an awareness of renal artery variations if surgical procedures are indicated in this region. Presentation and Intervention: A 41-year-old female patient was admitted to our hospital for preoperative staging of the rectum carcinoma. A computed tomography (CT) scan clearly revealed the presence of normally positioned small right and left renal arteries, and a large aberrant renal artery originating from the distal abdominal aorta in a case with a horseshoe kidney (HSK). A multidetector CT angiography was performed using a 256-detector row CT scanner to obtain an image of vascular structures and associated pathologies. CONCLUSION In this patient with HSK, the left renal vein compression was unusual and the CT examination provided a good delineation of vascular and urinary tract anomalies.
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Affiliation(s)
- Bulent Guvendi
- Department of General Surgery, Faculty of Medicine, Kafkas University, Kars, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
- *Hayri Ogul, MD, Kazìm Karabekir Mah. Terminal Cad., Site Polat Apt. B Blok, Kat 1, No. 2, TR—25240 Erzurum (Turkey), E-Mail
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Ng E, Campbell I, Choong AM, Dunglison N, Aziz M. Crossed Renal Ectopia and Aorto-Occlusive Disease: A Management Strategy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:371-4. [PMID: 26509134 PMCID: PMC4622029 DOI: 10.5090/kjtcs.2015.48.5.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/30/2015] [Accepted: 07/03/2015] [Indexed: 11/20/2022]
Abstract
We present a rare case of a patient with aortoiliac occlusive disease on the background of type A crossed renal ectopia, for whom open surgical intervention was required. Aortic exposure in patients with concomitant crossed renal ectopia can present technical challenges to the vascular surgeon. The knowledge of variations in the ectopic renal blood supply is of paramount importance when performing surgery to treat this condition and affects the choice of surgical exposure. We present and discuss the operative details of our patient and outline an approach to this subset of patients.
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Affiliation(s)
- Eugene Ng
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital ; Discipline of Surgery, School of Medicine, University of Queensland
| | - Ian Campbell
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital
| | - Andrew Mtl Choong
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital ; Discipline of Surgery, School of Medicine, University of Queensland
| | | | - Maged Aziz
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital ; Discipline of Surgery, School of Medicine, University of Queensland
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Frego M, Bianchera G, Angriman I, Pilon F, Fittà C, Miotto D. Abdominal Aortic Aneurysm with Coexistent Horseshoe Kidney. Surg Today 2007; 37:626-30. [PMID: 17593488 DOI: 10.1007/s00595-006-3451-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
Surgical repair of an abdominal aortic aneurysm (AAA) concomitant with a horseshoe kidney (HSK) may be technically demanding because of the complex anomalies of the kidney and of its collecting system and arteries, the greater risk of HSK-related complications, and the often unexpected intraoperative finding of HSK itself. We reviewed a database of more than 500 patients with AAA observed in our surgical department from 1994 to the time of writing. Five patients had AAA concomitant with HSK. Two of these patients did not undergo surgery because of the small dimension of the aneurysm or because of their poor health. The other three underwent successful repair of AAA with different techniques; namely, an aortobifemoral bypass via a thoracoabdominal retroperitoneal incision in one, a straight graft via an emergency median laparotomy in one, and an endovascular repair followed by open surgery 4 years later for endotension in one. Abnormal minor renal arteries were deliberately occluded and only one of these caused a minor renal infarct, but without functional impairment. These data and a review of the literature indicate that HSK should not preclude repair of coexistent AAA, as imaging procedures provide the information necessary to plan the best approach for each patient. Up-to-date surgical procedures, a posteriori retroperitoneal approach or endovascular repair, and deliberate occlusion of the minor renal arteries appear feasible and safe as they avoid most of the anatomical problems and provide results equivalent to those of uncomplicated aortic surgery.
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Affiliation(s)
- Mauro Frego
- First Surgical Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, Policlinico, Via Giustiniani 2, 35128, Padova, Italy
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Kwon TW, Sung KB, Kim GE. Experience of an abdominal aortic aneurysm in a patient having crossed ectopia with fusion anomaly of the kidney. J Korean Med Sci 2004; 19:309-10. [PMID: 15082911 PMCID: PMC2822319 DOI: 10.3346/jkms.2004.19.2.309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of surgically treated abdominal aortic aneurysm (AAA) in a patient having crossed ectopia with fusion anomaly of the kidney. One artery from the abdominal aorta above the aneurysm supplies the right kidney while three renal arteries (two from the aneurysm itself and one from the left common iliac artery) supply the crossed ectopic kidney. Preoperative imaging to define the arterial and collecting systems along with a detailed planning of the operation is essential to prevent ischemic renal injury as well as ureteral injury during AAA repair.
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Affiliation(s)
- Tae Won Kwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
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Toursarkissian B, Mejia A, Wholey MH, Lawler MA, Thompson IM, Sykes MT. Endovascular AAA Repair in a Patient With a Horseshoe Kidney and an Isthmus Mass. J Endovasc Ther 2001. [DOI: 10.1583/1545-1550(2001)008<0604:eariap>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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de Virgilio C, Gloviczki P, Cherry KJ, Stanson AW, Bower TC, Hallett JW, Pairolero PC. Renal artery anomalies in patients with horseshoe or ectopic kidneys: the challenge of aortic reconstruction. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1995; 3:413-20. [PMID: 7582997 DOI: 10.1016/0967-2109(95)94161-o] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Renal fusion or ectopia can present formidable challenges during aortic surgery. To evaluate morbidity and define optimal management, the clinical histories of 20 patients with renal fusion or ectopia who underwent 21 aortic procedures at the authors' institution over a 37-year period were reviewed. Indications for surgery included aortic aneurysm in 16 patients (infrarenal in 15 and thoracoabdominal in one) and aortoiliac occlusive disease in five (with renovascular hypertension in two). The abnormal kidney was detected before surgery in 13 patients (65%) by excretory urography, arteriography, computed tomography, or ultrasonography. Arteriography revealed multiple and/or anomalous renal arteries in nine of 12 patients studied. At surgery, 15 patients (75%) were found to have multiple or anomalous renal arteries. Six required renal revascularization (reimplantation four, endarterectomy one, aortorenal bypass one). The renal symphysis was divided in two patients. There were no operative deaths. Six major complications included bleeding requiring reoperation, renal failure requiring short-term dialysis, pancreatitis, gastrointestinal bleeding, pneumonia and thrombophlebitis. Preoperative aortography is recommended in patients with renal fusion or ectopia because of the high incidence of associated renal artery anomalies. The surgeon must be prepared to preserve or revascularize these anomalous renal arteries. Division of the renal symphysis is rarely required. Although perioperative morbidity is raised, aortic reconstruction in patients with renal fusion or ectopia can be safely performed without increased mortality.
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Affiliation(s)
- C de Virgilio
- Department of Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Lord RS, Reid CB, Zhang HQ, Graham AR. Complex abdominal aortic reconstruction. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1991; 61:103-13. [PMID: 2001194 DOI: 10.1111/j.1445-2197.1991.tb00185.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R S Lord
- St Vincent's Hospital, Surgical Professorial Unit, University of New South Wales, Sydney, Australia
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