Novel Management of Complicated Renal Artery Aneurysm: Laparoscopic Nephrectomy andEx-VivoRepair with Heterotopic Autotransplant

Abstract

Renal artery aneurysm (RAA) is an infrequently seen disease entity but one with the potential for significant morbidity and mortality. Complications related to RAA include pain, hematuria, hypertension, and, rarely, rupture. Management is often based on symptomatology or, if symptoms are not present, the potential for rupture with increased size. Treatment options include observation, endovascular methods, or open surgical approaches, including aneurysm repair or nephrectomy. Complex cases often preclude endovascular approaches. We report our initial experience with laparoscopic nephrectomy, ex vivo back-table repair of the aneurysm, and iliac fossa autotransplant in cases of complex RAA. Two patients underwent laparoscopic nephrectomy with RAA repair and heterotopic autotransplant from May 2006 to November 2008. Etiology of the RAA was atherosclerosis in one patient and idiopathic in the second. Laparoscopic nephrectomy and back-table arterial reconstruction was performed, including aneurysmectomy and ostial closure. Patient 2 needed a gonadal vein graft for arterial reconstruction. Both patients had autotransplant into the right iliac fossa. Both patients were women. Mean age was 52.5 years (range 39-66 yrs). Mean operative blood loss was 550 mL (range 350-750 mL). Mean length of stay was 5.5 days (range 5-6 d). Mean discharge creatinine level was 0.8 mg/dL (range 0.5-1.1 mg/dL). No perioperative complications were reported. At last follow-up, all patients are alive with functioning autotransplant and no evidence of functional impairment. Management of complex RAA with laparoscopic nephrectomy, extracorporeal repair, and autotransplant is a feasible and successful method with minimal morbidity.