АНЕВРИЗМИ НИРКОВИХ АРТЕРІЙ: ДІАГНОСТИКА ТА ХІРУРГІЧНЕ ЛІКУВАННЯ EX VIVO

Abstract

Renal artery aneurysm (RAA) is a rare disease that is detected in autopsy in 0.01 – 0.09% as a casual finding. The RAA are divided into: true aneurysms (saccular or fusiform), dissecting aneurysms (from the aorta, only from renal arteries), pseudoaneurysms, intrarenal aneurysms. The causes of RAA include: atherosclerosis, fibro-muscular dysplasia, hypertension, hydronephrosis, Ehlers-Danlos syndrome. In 90% of cases, RAA manifests itself in arterial hypertension. Abdominal pain, paresis of the intestine, the presence of pulsating formation, hematuria may indicate on increase in the size of the aneurysm or their dissection. The use of ultrasound duplex scan, CT, MRI and angiography can confirm the RAA in 0.3-2.5% in high-risk groups. Indications for surgical treatment include: RAA > 2 cm, RAA in women of childbearing age, abdominal or lumbar pain, hematuria, refractory to drug therapy arterial hypertension, functionally significant stenosis of RA with size of RAA > 1cm, thromboembolism, dissection, rupture of RAA. Surgical treatment of the RAA consists of: in situ reconstruction (in-situ prosthesis, tangential resection and angioplasty, nephrectomy), endovascular interventions (aneurysm embolization, stenting), extracorporeal reconstruction – ex vivo. The autotransplantation of the kidney with extracorporeal reconstruction of the renal artery with RAA of the second and third branching is an efficient method of treatment, which provides satisfactory long-term clinical results and is performed in cases when classical reconstruction or endovascular correction is impossible.