Complex Renal Artery Aneurysms Research Articles

Flow-diverter treatment for renal artery aneurysms: One-year follow-up of a multicentric preliminary experience.

PURPOSE Renal artery aneurysms (RAAs) are rare in the general population, although the true incidence and natural history remain elusive. Conventional endovascular therapies such as coil embolization or covered stent graft may cause sidebranches occlusion, leading to organ infarction. Flow-diverters (FD) have been firstly designed to treat cerebrovascular aneurysms, but their use may be useful to treat complex RAAs presenting sidebraches arising from aneurysmal sac. To evaluate mid-term follow-up (FUP) safety and efficacy of FD during treatment of complex RAAs. METHODS Between November 2019 and April 2020, 7 RAAs were identified in 7 patients (4 men, 3 women; age range 55-82 years; median 67 years) and treated by FD. Procedural details, complications, morbidity and mortality, aneurysm occlusion and segmental artery patency were retrospectively reviewed. Twelve months computed tomography angiography (CTA) FUP was evaluated for all cases. RESULT Deployment of FD was successful in all cases. One intraprocedural technical complication was encountered with one FD felt down into aneurism sac which requiring additional telescopic stenting. One case at 3 months CTA FUP presented same complication, requiring same rescue technique. At 12 months CTA FUP 5 cases of size shrinkage and 2 cases of stable size were documented. No rescue surgery or major intraprocedural or mid-term FUP complication was seen. CONCLUSION Complex RAAs with two or more sidebranches can be safely treated by FD. FD efficacy for RAA needs a further validation at long term FUP by additional large prospective studies.

Hilar Renal Artery Aneurysms Repaired Ex-Vivo with Autotransplantation

Renal artery aneurysms have an incidence of 0.1% with a rupture rate of 3-5% and mortality rate of less than 10% when excluding pregnant patients (1). Majority are found incidentally with no symptoms. Complex renal artery aneurysms in the hilum or at branching points with no endovascular repair options require open repair. Open repair options consist of in-situ repair or ex-vivo repair with autotransplantation.

Endovascular interventions in management of renal artery aneurysm.

Renal artery aneurysm (RAA) is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females for in which case patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization (SACE), balloon-assisted coil embolization (BACE), selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-hystroacril and onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization has been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.

Endovascular treatment of wide-necked aneurysms of the visceral and renal arteries using the double microcatheter technique via a single access route

We aimed to evaluate the utility of and complications associated with the double microcatheter technique for the treatment of wide-necked visceral and renal artery aneurysms (VRAAs). Nine patients (mean age, 58 years; age range, 42-69 years; 4 men, 5 women) with wide-necked VRAAs who underwent treatment with the double microcatheter technique from January 2016 to July 2018 were included in the study. For all patients, anatomical features were confirmed using cone-beam computed tomography (CT) with rotational angiography. The aneurysmal location, size, volume, neck-to-dome ratio, number of coils used, and coil packing density were investigated. Technical success, complications (coil migration and organ ischemia), changes in the complete blood count or serum creatine level, and recurrence were also evaluated. Three renal artery aneurysms and 6 splenic artery aneurysms were treated by the double microcatheter technique. The mean size of the aneurysms was 26.09±4.76 mm, mean volume was 6.19±3.69 cm3, and mean neck-to-dome ratio was 1.53±0.24. The number of coils used ranged from 7 to 16. The mean packing density was 11.32%±3.72%. Technical success was achieved in all 9 patients. Renal ischemia occurred in two patients with renal artery aneurysm, one of whom showed minimal scar formation on follow-up CT after infarction. No coil migrations or disease recurrences were observed. The double microcatheter technique for the treatment of wide-necked VRAAs appears to be relatively safe and useful. However, complex renal artery aneurysm should be carefully managed in order to prevent infarction.

How to do it: a robotic kidney autotransplant.

We describe Australia's first reported case of robotic kidney autotransplantation for a complex renal artery aneurysm. It is potentially a safe, minimally invasive method of salvaging renal parenchyma and preservation of renal function in patients with complex renovascular conditions. This technique shows promise in carefully selected patients performed in centres with surgeons experienced in both kidney transplantation and the robotic platform.

In Situ Treatment of Branch Renal Artery Aneurysms With Pantaloon Vein Graft.

The optimal method of operative management of complex renal artery aneurysms (RAAs) involving distal branches (BRAAs) remains unclear. When more than 1 artery is involved within the BRAA, endovascular techniques are not advisable and an ex vivo approach is often preferred. In this study, we introduce an alternative surgical in situ technique to treat BRAAs. Five aneurysms involving the main or second-order bifurcation of the renal artery (RA) were treated in 4 patients at our institute between November 2012 and January 2017. The treatment of the BRAAs was based on resection of the aneurysm wall and reconstruction with autologous Pantaloon vein graft (PVG): a "Y-shaped" bypass created on-bench with autogenous great saphenous vein. Sequential clamping/reperfusion of the kidney allows to reduce renal function impairment. No perioperative mortality or morbidity was observed, including none nephrectomy. In all the cases, aneurysms were treated with an in situ technique as previously planned. All the grafts were patent at the follow-up time (mean 64.1 ± 11.7 months). Renal function was preserved in all the cases. Vascularization of the renal parenchyma was satisfactory both on arterial echo Doppler and contrast-medium ultrasound in all the cases. Average cross-clamping times of the main RA and of a single branch RA were 15.8 ± 1.7 and 17.7 ± 4.6 minutes, respectively. Mean total operating time was 266.3 ± 18.9 minutes. The PVG with sequential clamping applied in the surgical treatment of BRAAs permits to reduce the ischemic effects to the renal parenchyma. To our knowledge, these are the first cases described in which BRAAs are treated with a PVG and our experience suggests that it is a feasible technique, with good long-term results and without severe adverse events recorded.

MISC 18. Surgical Treatment of Six Complex Renal Artery Aneurysms With Open "Ex Vivo” Technique

MISC 18. Surgical Treatment of Six Complex Renal Artery Aneurysms With Open "Ex Vivo” Technique

Robotic Renal Artery Aneurysm Repair

BackgroundRenal artery aneurysm (RAA) is a rare condition, traditionally managed with endovascular or open surgical techniques. ObjectiveTo report our experience with robotic RAA repair. Design, setting, and participantsNine consecutive patients underwent intracorporeal robotic surgery for 10 RAAs. Surgical procedureTwo patients underwent concomitant robotic partial nephrectomy. One patient had RAA in a solitary kidney. Median RAA diameter was 2.2 (1.8–3)cm. Intracorporeal transarterial hypothermic renal perfusion was performed in five patients. Robotic techniques included tailored aneurysmectomy and repair (n=5), excision with end-to-end anastomosis (n=2), aneurysmectomy with branch reimplantation (n=1), prosthetic interposition graft repair (n=1), and simple nephrectomy (n=1; this patient's data were excluded from analysis). MeasurementsDemographics, RAA characteristics, intraoperative techniques, perioperative outcomes, and follow up data were analyzed. Aneurysms were diagnosed by computed tomography, angiography, or incidentally during the performance of a partial nephrectomy. Results and limitationsAll cases were performed robotically, without conversion to open surgery. Median (range) operative time was 3.8 (3–6)h, warm ischemia time 26 (19–32)min, hypothermic renal perfusion time 34 (29–69)min, and estimated blood loss 100 (25–400)ml. No intraoperative blood transfusion was required. Median hospital stay was 3 (2–6)d. One patient had a Clavien-Dindo grade II complication. At median follow-up of 16 (2–67)mo, all patients had preserved renal function. Follow-up imaging confirmed normal caliber reconstructed renal arteries with globally perfused kidneys, except for two kidneys with small segmental infarcts due to an intentionally ligated small polar vessel. Limitations include the small number of patients and the retrospective nature of the study. ConclusionsRobotic repair of complex RAAs is feasible. Surgical expertise, patient selection, and RAA-specific vascular reconstruction are critical for success. Greater experience is needed to evaluate the proper place of robotic repair of RAAs. Patient summaryWe report intracorporeal robotic repair for complex renal artery aneurysms. This robotic operation is feasible and safe, and replicates open principles. However, it requires considerable experience and expertise.

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

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.

Repair of Complex Renal Artery Aneurysms by Bench Surgery with Angioplasty and Autotransplantation: Three Case Reports

Repair of Complex Renal Artery Aneurysms by Bench Surgery with Angioplasty and Autotransplantation: Three Case Reports

V06-05 ROBOTIC RENAL ANEURYSM REPAIR: USC EXPERIENCE

You have accessJournal of UrologyAdrenal, Testis, UTUC Oncology & More1 Apr 2018V06-05 ROBOTIC RENAL ANEURYSM REPAIR: USC EXPERIENCE Luis Medina, Giovanni Cacciamani, Andre Abreu, Akbar Ashrafi, Matthew Winters, Sameer Chopra, Carlos Fay, Karan Gill, Hannah Landsberger, Rene Sotelo, and Inderbir Gill Luis MedinaLuis Medina More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Andre AbreuAndre Abreu More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Matthew WintersMatthew Winters More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Carlos FayCarlos Fay More articles by this author , Karan GillKaran Gill More articles by this author , Hannah LandsbergerHannah Landsberger More articles by this author , Rene SoteloRene Sotelo More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1584AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal artery aneurysm (RAA) is a rare clinical condition and is traditionally managed with endovascular techniques when treatment is indicated. There are few reports within the literature demonstrating minimally-invasive techniques for surgical intervention. We previously described the initial case of laparoscopic RAA repair. Herein, we report our experience of minimally-invasive RAA repair in six patients. METHODS Five patients had a complex RAA involving the main renal artery, and one patient had multiple aneurysms. Five patients underwent reconstruction robotically with one patient undergoing a robotic graft repair. RESULTS Median (range) aneurysm size was 2.4 cm (1.8-3.0). Median (range) operative time was 4.0 hours (3.5-6.0) with a median (range) warm ischemia time of 31.0 min (3-32). Median (range) estimated blood loss was 125 (50-400) and no patient required an intra-operative blood transfusion. Median (range) length of hospital stay was 3 days (2-6). At a median (range) follow up of 31.5 months (1-67), all patients report to be doing well with no post-operative complications. CONCLUSIONS Our experience demonstrates that minimally-invasive techniques can be utilized to treat such rare cases as RAA. This study further advances the field. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e662 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Luis Medina More articles by this author Giovanni Cacciamani More articles by this author Andre Abreu More articles by this author Akbar Ashrafi More articles by this author Matthew Winters More articles by this author Sameer Chopra More articles by this author Carlos Fay More articles by this author Karan Gill More articles by this author Hannah Landsberger More articles by this author Rene Sotelo More articles by this author Inderbir Gill More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical planning with three-dimensional printing of a complex renal artery aneurysm

Surgical planning with three-dimensional printing of a complex renal artery aneurysm

V11 - Ex vivo repair and autotransplantation for complex renal artery aneurysms

V11 - Ex vivo repair and autotransplantation for complex renal artery aneurysms

Surgical repair of a complex renal artery aneurysm through bench surgery and autotransplantation

Abstract A 58-year-old woman with underlying medically controlled hypertension presented after an episode of sudden-onset chest pain. Chest computed tomography imaging revealed a left renal artery aneurysm (RAA) measuring 1.6 cm in diameter with mural thrombi in the distal left renal artery at bifurcation level. An interval enlargement of approximately 0.4 cm in diameter was noted within a 6-month period; however, endovascular intervention was not feasible because of the complex RAA pattern. She was hospitalized and received a hand-assisted laparoscopic nephrectomy, ex vivo repair of the RAA, and autotransplantation into the left iliac fossa. The procedure was successful, and the postoperative course went smoothly. The kidney graft was evaluated using a magnetic resonance angiography 1-year postoperatively, which showed no signs of surgical complications or RAA recurrence.

Endovascular management of renal artery aneurysms using the multilayer flow modulator

ObjectiveOur aim was to describe our experience of the Multilayer Flow Modulator (MFM, Cardiatis, Isnes, Belgium) used in the treatment of type III renal artery aneurysms (RAA).MethodsThis is a single-centre...

Enlarged and Colored Enhanced 3D Printing of Renal Artery Aneurysms for Improved Imaging and Treatment Planning

Three dimensional printing (3D printing) technology is increasingly used to improve results in many areas of medicine. Physical models produced by this technology allow better appreciation of complex anatomical and pathologic conditions. In cardiovascular medicine and surgery, 3D modeling has been reported to be of help in treatment planning of abdominal aortic aneurysm, especially in cases of complex angulations and branching at the aneurysm neck. Here we report the use of 3D printing in cases of renal aneurysms. Enhanced 3D models of CTA images of renal aneurysms were prepared in house using common and freely available software programs, and an accurate desktop 3D printer. Eight reconstructed models were enlarged by a factor of 2 or more and then differentially painted to delineate normal arteries and aneurysmatic ones. These enhanced 3D solid models allowed visual and tactile inspection for a better appreciation of complex aneurysms. Color enhancement of these models added another dimension of comprehension, even for experienced surgeons and invasive radiologists, and allowed more accurate measurements of branch numbers, distances, and angles in space even with severe tortuosity. Endovascular use of covered stents and embolization techniques could be easily envisioned preoperatively. We conclude that enhanced, enlarged, and colored 3D printed models are a powerful tool for preoperative endovascular treatment planning of complex renal artery aneurysms.

Case report – Surgical repair of complex renal artery aneurysm by bench surgery and autotransplantation

Case report – Surgical repair of complex renal artery aneurysm by bench surgery and autotransplantation

CIRUGÍA DE BANCO Y AUTOTRASPLANTE EN ANEURISMA COMPLEJO DE ARTERIA RENAL

complex renal artery aneurysm. ex vivo repair and reimplantation introduction: True incidence of renal artery aneurysms is unknown but it has been estimated to be around 1%. They are usually asymptomatic and diagnosed through imaging studies done for other medical reasons. Those that are more than 2 cm in diameter or any aneurysm in pregnant women should be treated because of an elevated risk of rupture. We present a case of a man with a complex 2.5 cm renal artery aneu- rysm, successfully treated with ex vivo repair and reimplantation by a multidisciplinary team.

Vascular fluorescence imaging control for complex renal artery aneurysm repair using laparoscopic nephrectomy and autotransplantation.

Intraoperative fluorescent imaging using indocyanine green enables vascular surgeons to confirm the location and states of the reconstructed vessels during surgery. Complex renal artery aneurysm repair involving second order branch vessels has been performed with different techniques. We present a case of ex vivo repair and autotransplantation combining the advantages of minimally invasive surgery and indocyanine green enhanced fluorescence imaging to facilitate vascular anatomy recognition and visualization of organ reperfusion.

Bilateralex vivorepair and kidney autotransplantation for complex renal artery aneurysms: A case report and literature review

We report the surgical management of a bilateral renal artery aneurysm diagnosed in a 41-year-old patient with a history of recurrent abdominal pain. The preoperative contrast-enhanced computed tomography showed a complex saccular aneurysm on both renal arteries within the renal hilum. The characteristics of aneurysms precluded endovascular procedures, and a double-step bilateral ex vivo reconstruction with kidney autotransplantation was planned. The intra- and postoperative period was uneventful. Imaging and laboratory examinations show preservation of renal function, and patient is symptom-free at 10-month follow up.