Successful endovascular management of renal artery aneurysm containing several outflow vessels supplying significant part of the renal parenchyma

Abstract

Background: Complex renal artery aneurysms (RAAs) represent a therapeutic challenge, especially in those who contain branches of the renal artery. Treating the RAA may compromise renal perfusion, cause ischemia, and significant parenchymal loss. Purpose: The current report describes a rare case of complex RAA with three dependent arterial branches, successfully managed by a flow diverting stent (FDS) which is usually indicated for the treatment of large and giant cerebral aneurysms. Methods: We report a case of a 61-year-old male who presented with a 2.3 cm left RAA which contained the origin of three major arterial branches that provide a significant part of the blood supply to the entire left kidney. Due to the existence of these three branching blood vessels within the aneurysm, a standard stent-graft or an open procedure were not considered as adequate therapeutic alternatives in this case. To overcome this challenge, we have elected to use an FDS which is commonly used in the treatment of cerebral aneurysms. This unique type of stent promotes gradual thrombosis of the aneurysmal sac with the advantage of maintaining flow in regional side branches. Results: At 6 months of follow up, creatinine level was 1.3 mg/dL (baseline was 1.1) and upon follow up CT - the renal parenchyma was well preserved. Conclusions: This case report presents a unique solution for treating complex RAA by using an FDS that is routinely used for the treatment of large and giant cerebral aneurysms. FDS is a valuable treatment option for complex RAAs since it can treat the aneurysm without compromising the branching blood vessels.