Діаґностика та хірурґічне лікування аневризм ниркових артерій

Abstract

Aim. Improvement of diagnosis and surgical treatment of renal artery aneurysms.  Material and Methods. The features of the clinical course, diagnosis and surgical treatment of renal artery aneurysm were analyzed in a 55-year-old patient. Results and Discussion. In our observation, in a 55-year-old patient, by clinical examination, laboratory and diagnostic imaging the following diagnosis was confirmed: Atherosclerosis. Aneurysm of the right renal artery. Moderate ectasia of the left renal artery trunk. Condition after stent-graft implantation into the right renal artery (25.06.2018), embolization of a pseudoaneurysm of the right renal artery (22.11.2018). Arterial hypertension, Stage II, risk 4. Presence of a drug-resistant hypertension, a saccular renal artery aneurysm with 2.0 cm in diameter, and unsuccessful attempts to use endovascular methods of treatment have become direct indications for surgical intervention, not only saving patient's life, but also preventing the development of fatal complications. Surgical treatment of the renal artery aneurysms consists of: endovascular interventions (aneurysm embolization, stenting), in situ reconstruction (in-situ prosthesis, tangential resection and angioplasty, nephrectomy), extracorporeal reconstruction - ex vivo. Nephrectomy is recommended in cases of multiple large intrarenal aneurysms, concomitant renal pathology (atrophy, tumor), rupture of aneurysms in patients in a shock condition, and previously unsuccessful reconstructive interventions. Conclusions. Renal artery aneurysm is a rare clinical condition that may be complicated by rupture and fatal bleeding. This clinical case demonstrates that adequate surgical treatment - resection of sac-like aneurysm in vivo allowed not only to prevent the occurrence of life-threatening complications, but also to achieve complete recovery of the patient.