Surgical repair of an abdominal aortic aneurysm in a patient with a horseshoe kidney is complicated by which anomaly?

• A. Absent renal arteries
• B. Renal vein anomalies
• C. Anomalous origins of multiple renal arteries
• D. Ureteral duplication

Answer: (C)

Horseshoe kidney commonly has multiple renal arteries that arise from the aorta or iliac vessels to supply the kidneys and the connecting isthmus. This variation means there may be several accessory arteries that need to be identified and preserved or reimplanted during abdominal aortic aneurysm repair. If these anomalous arteries are missed or inadequately managed, renal perfusion can be compromised, leading to renal ischemia or failure.

So the situation is complicated primarily by the anomalous origins of multiple renal arteries feeding the kidneys. The other possibilities—such as absent renal arteries, renal vein anomalies, or ureteral duplication—are not the usual or main surgical challenge in this context.