Extracorporeal resection of renal artery aneurysm and separate autogenous vein graft repair of its branches in a patient with retroaortic renal vein

Abstract

Autopsy and intravital studies have reported the incidence of renal artery aneurysms (RAA) in 0.01 to 0.97% of the population. Fibromuscular dysplasia (FMD) and atherosclerosis are the main etiological factors for the development of RAA. The presence of abnormalities of the veins such as a retroaortic renal vein can significantly complicate the implementation of surgical interventions. The main methods to treat RAA are RAA resection with prosthetic repair, embolization of aneurysm cavities, and placement of an endograph. When aneurysm spreads to involve the renal artery branches or RAA is located in the kidney gates, the extracorporeal renal artery reconstruction is the only method to restore the renal vessels and keep a kidney. The article provides a rare observation of a patient suffering from renal artery fibromuscular dysplasia, left renal artery aneurysm with the development of vasorenal hypertension. The features of this clinical observation were the retroaortic left renal vein and the renal artery aneurysm located in the kidney gates. The patient underwent ureter-sparing extracorporeal autogenous vein graft repair of left renal artery branches. The surgery was performed using custodial solution for kidney pharmaco-hypothermic protection. Renal artery aneurysm was resected with the creation of a common junction of the renal artery branches followed by autogenous vein graft repair. The two lower segmental branches of the renal artery were separately prosthetized using the reversed autovein sections. Parietal injury to the left ureter was diagnosed in the patient in the postoperative period. A percutaneous needle-guided urine drainage bag was superimposed under ultrasound guidance with the placement of an integral stent in the injury area. The patient was discharged to outpatient care on Day 11. The urine drainage bag was removed two months after the control CTA. The integral stent was removed a month later, normal urine output was restored in the upper urinary tract. After 6 months, the control CTA showed that all reconstructed renal artery branches were completely patent, and blood pressure readings were within normal range.