Abdominal Aortic Aneurysm and Polycystic Kidneys

Rudolph G. Vanmaelé, MD, PhD, Division of Thoracic and Vascular Surgery, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium) Dear Sir, The association of autosomal dominant polycystic kidney disease (ADPKD), also known as adult polycystic kidney disease, with various cardiovascular disorders is well known. The diagnosis of abdominal aortic aneurysm (AAA) associated with ADPKD has been reported in only a few cases. A personal case of successful aneurysmectomy is reported and incidence and treatment of AAA in the ADPKD patient population are discussed. A 48-year-old Caucasian male, with known ADPKD, arterial hypertension, and chronic renal failure since 1979, was admitted in March 1991. During the last year he complained of progressive abdominal pain, essentially in the left flank, irradiating to both legs. At physical examination, the abdomen was tender and distended by two very large polycystic kidneys palpable as far as the midline. Peripheral arterial pulses were normal. The systolic blood pressure was 170 mm Hg upon admission. Other physical findings were irrelevant. Serum creatinine was 3.7 mg/dl (320 μmol/l). Computed tomography of the abdomen showed voluminous polycystic kidneys, liver cysts, and a 5 cm wide fusiform infrarenal aortic aneurysm, however, without signs of leakage. There was no evidence of other cardiovascular abnormalities. The pain was attributed to the cystic kidneys, and the patient was transferred to the Department of Vascular Surgery for further investigation and elective aneurysmectomy. During the operation, the kidneys were carefully retracted laterally as far as possible, giving limited access to the aneurysm and the aortic bifurcation. After opening of the aneurysmal sac, an aortobifemoral bypass with a bifurcated Dacron prosthesis was performed. The postoperative course was uneventful. Pedal pulses were normal, and serum creatinine remained at the preoperative level during 10 months. After this period, the renal function started slowly deteriorating. At the present time, 30 months after surgery, serum creatinine is 6.3 mg/dl (546 μmol/l), but the patient is still not under dialysis treatment, and he remains in good general condition without vascular symptoms. ADPKD is frequently associated with lesions in the cardiovascular system. In a combined retrospective and prospective study, the incidence was estimated to be 18% by clinical