Chapter 131 - Renovascular Disease: Aneurysms and Arteriovenous Fistulae

Abstract

Renal artery aneurysms and arteriovenous fistula (AVF) are rare conditions, and therefore indications for treatment may be unknown or based on descriptive data and case reports. Asymptomatic renal artery aneurysms in men and in women who are not of childbearing age can generally be followed until they are more than 3 cm in diameter because of the low risk of rupture. Any size renal artery aneurysm needs to be repaired in women of childbearing age. Calcification is not protective against rupture. Endovascular interventions are generally the first-line treatment for most renal artery aneurysms. Treatment includes insertion of a stent graft, embolization, other endovascular interventions, or open surgical repair. Renal arteriovenous fistulae (AVFs) are usually asymptomatic, but when symptomatic or causing hypertension, can usually be treated by coil embolization. Renal artery aneurysms and renal AVFs are discussed separately because they rarely occur concomitantly and their clinical course and treatment differ.