2201 LONG-TERM OUTCOMES OF RENAL ARTERIAL ANEURYSM; A COMPARISON BETWEEN CONSERVATIVE THERAPY AND SURGICAL TREATMENTS IN SINGLE CENTER ANALYSIS

Abstract

INTRODUCTION AND OBJECTIVES: Since spontaneous rupture risk assumed to be extremely lower in renal arterial aneurysm (RAA), the rarity and variable clinical course has annoyed surgical indication of RAA. Long-term follow-up study of conservative management for RAA has been scarcely reported. The aim of this study was to evaluate long-term outcomes of active surveyllance and surgical repair in patients with RAA. METHODS: The study included 58 patients who were diagnosed as RAA over the past 21 years (male: 17, female: 41). Median age at the time of diagnosis was 62 years (19–85 year range), and the median follow-up period was 69 months (3–216 month range). The conservative group (n 30) included patients who have been followed under strict blood pressure control. The treatment group (n 29) included patients who underwent surgical repair or radiological intervention. Differences between the groups in clinical backgrounds, RAA characteristics, clinical course and renal function were evaluated. Our tentative criteria of patient selection for the conservative group was age at 40 years or older, 20 mm or smaller in maximum aneurysm diameter and high degree of aneurysmal calcification. They had been followed up under careful blood pressure control and evaluated their renal function, RAA image on CT scan / ultrasonogram annually. RESULTS: Twenty-one cases of the treatment group underwent ex-vivo aneurysmal repair, while 4 cases underwent in-situ repair. In the other 4 cases, 2 underwent nephrectomy and 2 underwent trans-arterial embolization. Smoking habits at the time of diagnosis were found in 5 (16.7%) or 15 (51.7%) cases in the conservative or treatment group, respectively (p 0.024). Multiple efferent aneurysmal branches were found in 7 (23.3%) or 16 (55.2%) cases, respectively (p 0.002). Median maximum diameter of aneurysm was significantly lower in conservative group (15 vs. 25mm, p 0.005). All patients were alive except for 2 cases in conservative group, who were died in the other reasons. Increasing in size of RAA was observed in only 2 cases of conservative group. Cumulative postoperative complications (autotransplanted graft dysfunction or post-operative urinary tract complication, et al.) occurred 15/27 (55.6%) in the treatment group. No significant difference was observed in renal function between the two groups. CONCLUSIONS: The conservative approach of RAA could be expanded under appropriate management for hypertension and careful observation for RAA, otherwise surgical repair would be with discretion for obviating the surgical adverse events.