A high-risk patient underwent exclusion of an abdominal aortic aneurysm with aortofemoral bypass. During the procedure a horseshoe kidney was found to be overlying the aorta. Postoperatively retrograde perfusion of the aneurysm via a recanalized right iliac artery occurred and led to doubling of the aneu rysm's size, necessitating reoperation. The operative approach and pertinent literature are reviewed.
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