Renal Aneurysm Research Articles

Polyarteritis nodosa complicated by renal aneurysm and intestinal perforation: A case report.

Polyarteritis nodosa (PAN) is a necrotizing vasculitis that affects small- and medium-sized arteries, presenting with diverse clinical manifestations. It can impact tissues and organs throughout the body and may be life-threatening in severe cases. Common causes of death include cardiac, renal, and gastrointestinal complications or aneurysm rupture. While separate reports of renal aneurysm and intestinal perforation exist, the coexistence of these conditions is rarely documented. This study reports a severe case of PAN complicated by both renal aneurysm and intestinal perforation, aiming to deepen the understanding of this disease, aid in clinical diagnosis and treatment, and improve patient prognosis. The patient presented to the hospital with dorsal foot pain and abdominal pain persisting for more than 4 months, along with pain and discomfort in both lower extremities for over 1 month. The patient was diagnosed with PAN, renal aneurysm, intestinal perforation, and grade 3 hypertension (high risk). After treatment, the patient showed normal temperature and blood pressure, relief from abdominal pain, and disappearance of myalgia and numbness in the lower limbs. Additionally, the renal aneurysm shrank significantly, the intestinal perforation healed, the ileostomy was reduced, and the patient's condition stabilized. The clinical symptoms of PAN mostly lack specificity, and should be distinguished from microscopic polyangiitis and simulated vasculitis. For patients with intestinal perforation similar to this case, tocilizumab treatment may be effective, but further research is needed to confirm it.

Commentary: Eighteen cases of renal aneurysms: clinical retrospective analysis and experience of endovascular interventional treatment.

Commentary: Eighteen cases of renal aneurysms: clinical retrospective analysis and experience of endovascular interventional treatment.

Eighteen cases of renal aneurysms: Clinical retrospective analysis and experience of endovascular interventional treatment.

Development of endovascular interventional techniques gradually replaced traditional open surgery and has become the preferred treatment for renal aneurysms. This study aimed to analyze the clinical characteristics of renal artery aneurysm (RAA) and the safety and efficacy of intravascular interventional treatment. We retrospectively analyzed the clinical characteristics and imaging data of 23 aneurysms in 18 patients with RAA. The technical success rate, complication rate, mortality rate, reintervention rate, and use of embolization materials were evaluated. In 18 patients with RAA (age, 32-72 years, average age, 52.2 ± 11.2 years), a total of 23 aneurysms were found (diameter 0.5-5.5 cm, average diameter 2.2 ± 1.4 cm). Among them, 11 cases (61.1%) were discovered accidentally, and the remaining patients were diagnosed due to the following major complaints: four cases (22.2%) presented low back pain, two (11.1%) were due to high blood pressure, and one (5.5%) had low back pain with gross hematuria. A total of 14 aneurysms in 13 patients received endovascular interventional therapy. The technical success rate of 13 patients with renal aneurysms was 100%. Three of the 18 patients were lost to follow-up, and the remaining were followed up for 4-89 months. There was no recurrence of the aneurysm or displacement of the stent or coil. Endovascular treatment for RAA has a high success rate, low complication rate, and low reintervention rate. It has the advantage of less trauma and is flexible and more targeted for different types of renal aneurysms.

Treatment of a Complex Renal Aneurysm by Simple Nephrectomy

A renal artery aneurysm is a dilated segment of the renal artery that is larger than twice the diameter of a normal renal artery. Despite its rarity, the diagnosis and incidence of this entity have been steadily increasing as a result of the widespread use of cross-sectional imaging. Renal artery aneurysms can be clinically significant and potentially fatal in some cases. However, knowledge of their occurrence, natural history and prognosis, whether treated or not, is limited. We present a case of a renal artery aneurysm complicated by hypertension that did not respond to medical treatment and was treated with simple nephrectomy.

Consequences of the coverage of polar renal arteries due to the treatment of the juxtarenal aneurysms with fenestrated stentgrafts

To evaluate the short and mid-term consequences on the renal function and the mortality of the coverage of polar renal arteries during the endovascular treatment of juxtarenal renal aneurysms (JRA) with fenestrated stentgrafts.

Double strengthening of the neck of the aortic aneurysmal sac

INTRODUCTION. The article presents the experience of treatment of abdominal aortic aneurysms from 2011 to 2016 using the author’s technology, which contains the method of double strengthening of the neck of the aortic aneurysm, on the basis of the Department of Hospital Surgery in the Department of Vascular Surgery of the RCH of Nalchik.METHODS AND MATERIALS. According to this method, 202 patients with abdominal aortic aneurysm (group I) were operated on, 116 were admitted as planned, 86 were admitted as emergency and urgent, while 183 were men and 19 were women. Without using the technique of double strengthening of the aneurysm neck, 205 patients were selected for the period from 2006 to 2011. They were included in group II. Among them, 118 were received as planned, 87 were received in special and urgent cases. The patients were examined thoroughly. CT angiography in 3-dimensional reconstruction was performed using special research methods.RESULTS. All patients were transferred to the intensive care unit after the operation. In the operative and immediate postoperative periods, among the operated patients admitted in an emergency and urgent, 19 patients with a ruptured aortic aneurysm died in group I, 23 patients – in group II. Among the planned patients, 2 in group II died from a combined severe concomitant pathology. All other patients were activated on the 2nd-3rd day, and subsequently discharged in a satisfactory condition.CONCLUSION. The advantages of the proposed method of surgical treatment of abdominal aortic aneurysm are: technical simplicity of execution, double strengthening of the neck of the aneurysmal sac, tightness of the anastomosis, therefore, the reduction of intraoperative blood loss, the possibility of performing aortic prosthetics with suprarenal and renal aneurysms and weakness of the wall in the neck area in the absence of an artificial circulation apparatus.

Surgical treatment of visceral and renal abdominal artery aneurysms of various etiology

Visceral artery aneurysms are detected when complications occur or accidentally during examination for other diseases gastrointestinal tract, aimed at determining the functional significance. Over the past 10 years, we have observed 31 patients with abdominal visceral artery aneurysms, 10 patients had renal aneurysms, 15 had splenic arteries, hepatic artery and pancreatoduodenal artery aneurysms – in one case. The combination of aneurysms – in 2 cases: in one case – the renal artery with the splenic artery, in the other – the renal artery and the abdominal trunk. The patients ranged in age from 24 to 78 years, the average age is 43±6.5. Previously, infection was considered the most common cause of splenic artery aneurysms in 10 cases, with most patients complaining of fever, abdominal pain and a pulsating mass in the abdomen. And two patients with splenic artery aneurysm noted abdominal trauma. 3 had atherosclerotic changes. The causes of renal artery aneurysms are atherosclerosis in 6 cases, fibromuscular dysplasia in 2 cases, and Nonspecific aortoarteritis in 2 cases. Also, atherosclerotic etiology is present in aneurysms of the external iliac arteries aneurysms. Reconstructions on hepatobiliary aneurysms were performed in 6 (20%) cases, in 5 cases - resection with end-to-end anastomosis and in 2 cases - resection of splenic artery aneurysm, resection of splenic artery aneurysms with autovenous patch, clipping of splenic artery aneurysms – in 2 cases (6.5%), endovascular techniques were applied in 18 cases (58%). In 2 cases, nephroectomy was performed due to the spread of the aneurysm into the kidney gate and the lack of conditions for reconstruction. In the immediate and long-term (after 6 months and 3 years) postoperative period, the preservation of organ function in reconstructive and ligating methods of surgical treatment is the same. Signs of ischemia and impairment in the immediate postoperative period were not observed with reconstructive and ligating methods of surgical treatment. The choice of treatment method depends on the severity of the patient’s condition, clinical manifestations, as well as the localization of the aneurysm and its morphology. Preference is given to endovascular techniques, which are not traumatic enough and provide a good long-term result. However, in each case, the patient’s management tactics are individual, the choice of the optimal method of treatment of visceral artery aneurysms is based on data from the entire spectrum of possible diagnostic manipulations.

Simultaneous spontaneous dissection of right carotid and left vertebral artery followed by spontaneous coronary artery dissection in a patient with renal fibromuscular dysplasia and aneurysm.

Simultaneous spontaneous dissection of right carotid and left vertebral artery followed by spontaneous coronary artery dissection in a patient with renal fibromuscular dysplasia and aneurysm.

Endovascular Treatment of a Giant Renal Vein Aneurysm Arising from a High-Flow Arteriovenous Fistula.

Background:Renal vein aneurysms (RVAs) are considered rare clinical entities. RVAs can be secondary to thrombosis, venous hypertension, or renal arteriovenous fistula (RAVF). RVAs secondary to RAVF are rare. Patients with RVA may present with hypertension, abdominal pain, hematuria, or may even be asymptomatic. However, there may be life-threatening emergencies including aneurysm rupture, thrombosis, and pulmonary embolism. The treatment of RVAs includes reconstruction of the renal vein, nephrectomy, and endovascular treatment. Purpose:In this technical note, we report the endovascular treatment of a giant RVA that developed secondary to an acquired RAVF by the placement of multiple vascular plugs. Conclusion:Endovascular occlusion of the RAVF with vascular plugs is effective to prevent a life-threatening rupture of RVA. Clinical follow-up is crucial to detect leakage or migration of the vascular plugs.

Endovascular management of a large renal artery aneurysm: a case report and review of the literature

BackgroundA renal artery aneurysm is a rare clinical presentation that can be found incidentally on imaging or during workup for refractory hypertension. Its presentation can be similar to that of a renal artery pseudoaneurysm, but the etiologies of the two vascular lesions differ. We present a patient who had an incidental finding of a large renal artery aneurysm that was managed with endovascular embolization. We also describe the literature surrounding the etiology, presentation and management of both renal artery aneurysms and renal artery pseudoaneurysms.Case presentationA 62-year-old man was referred to a urologic oncologist for workup of a newly found renal mass. Initial imaging with computed tomography showed a homogenous, well-circumscribed mass arising from the right kidney. Further evaluation with Doppler ultrasonography demonstrated pulsatile flow within the renal mass that was concerning for a renal artery pseudoaneurysm. The patient initially underwent a diagnostic angiogram by interventional radiology and was found to have a true renal artery aneurysm. Interventional radiology considered placement of a covered stent or angioembolization, but treatment was deferred due to concern for compromising the patient’s renal function. Patient was subsequently transferred to a neighboring hospital for management by vascular surgery. After considering both open surgical and endovascular approaches, the patient ultimately underwent angioembolization of the renal artery aneurysm. Short-term follow-up showed successful exclusion of the aneurysm with minimal adverse effects to the patient.ConclusionsOur case report documents a unique case of an incidentally found large renal artery aneurysm that was successfully managed with endovascular embolization. Renal artery aneurysms and renal artery pseudoaneurysms, which can present similarly on imaging, are important diagnostic considerations in a patient presenting with a new renal mass. While open surgical approaches can be used to repair aneurysms, endovascular approaches using stenting or angioembolization are safe and effective options for treating renal aneurysms and renal pseudoaneurysms.

The Renal Vasculature: What the Radiologist Needs to Know.

The physiologic role of the kidneys is dependent on the normal structure and functioning of the renal vasculature. Knowledge and understanding of the embryologic basis of the renal vasculature are necessary for the radiologist. Common anatomic variants involving the renal artery (supernumerary arteries and prehilar branching) and renal vein (supernumerary veins, delayed venous confluence, retroaortic or circumaortic vein) may affect procedures like renal transplantation, percutaneous biopsy, and aortic aneurysm repair. Venous compression syndromes (anterior and posterior nutcracker syndrome) can be symptomatic and can be diagnosed with a combination of radiologic features. Renal artery stenosis is commonly atherosclerotic and is diagnosed with Doppler US, CT angiography, or MR angiography. Fibromuscular dysplasia, the second most common cause of renal artery narrowing, has a characteristic string-of-beads appearance resulting from multifocal stenoses and dilatations. Manifestations of renal vasculitis differ depending on whether the affected vessels are large, medium, or small. Renal vascular injury is graded according to the American Association for the Surgery of Trauma (AAST) renal injury scale, which defines vascular injury and active bleeding in renal injuries. Both renal arteries and veins are affected by primary neoplasms or secondarily by neoplasms from adjacent structures. Differentiation between bland thrombus and tumor thrombus and the extent of involvement dictate management in malignancies, especially renal cell carcinoma. Aneurysms, pseudoaneurysms, arteriovenous malformations, and arteriovenous fistulas can affect renal vessels and can be diagnosed with specific imaging features. The radiologist has a critical role in identification of specific imaging characteristics and establishing the diagnosis in the varied pathologic conditions affecting the renal vasculature, which is critical for directing management. Thus, the renal vasculature should be an integral part of radiologists' checklist. ©RSNA, 2021.

Endovascular Interventional Radiology of the Urogenital Tract.

Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial embolizations. At the kidney level, arterial embolizations are performed mainly for palliative treatment of parenchymal tumors, for renal traumas and, less frequently, for arteriovenous fistulas and renal aneurysms and pseudoaneurysms. These latter may often require emergency intervention as they can cause renal or peri-renal hematomas or significant hematuria. Transcatheter arterial embolization is also an effective therapy for intractable severe bladder hematuria secondary to a number of neoplastic and inflammatory conditions in the pelvis, including unresectable bladder cancer and radiation-induced or cyclophosphamide-induced hemorrhagic cystitis. Endovascular interventional procedures for the penis are indicated for the treatment of post-traumatic priapism. In this article, we review the main endovascular radiological interventions of the male urogenital system, describing the technical aspects, results, and complications of each procedure at the various anatomical districts.

Use of Interventional Neuroradiology Devices (Solitaire AB and Cascade Net) in the Treatment of Complex Renal Aneurysms through Stent-Assisted Coil Embolisation

Introduction: The risk of rupture of true renal artery aneurysms is low but when they are bigger than 2 - 2.5 cm it increases significantly, making treatment essential. The need to use alternatives to conventional techniques in order to avoid predictable complications as coil migration is mandatory. Discussion: Routinely-used techniques in interventional neuroradiology such as flow diverters or those assisted with an occlusion balloon or stent have are suitable alternatives for complex aneurysms. Conclusion: Interventional neuroradiology devices such as the Cascade Net stent (Perflow Medical and Grupo Logsa) and Solitaire AB stent retriever (Medtronic) are valid and safe options. We describe the technique of such devices.

Endovascular Management of Renal Arteriovenous Fistula With Large Aneurysm Masquerading as a Renal Cyst

Large renal aneurysms can masquerade as simple renal cysts on ultrasound, especially if Doppler examination is not routinely done to assess flow characteristics. We present a case report of a 26-year-old male, as a clinical challenge in urology, who had minimal symptoms, yet had an arteriovenous fistula with a large aneurysm which was diagnosed as a parapelvic cyst on ultrasound. Endovascular treatment of the arteriovenous fistula was done using a vascular plug with satisfactory outcomes.

Large calcified renal artery aneurysm in the renal sinus misdiagnosed as an intrapelvic calculus followed by mistakenly performed PCNL: a case report

BackgroundRenal artery aneurysms (RAAs) are rare and usually asymptomatic, and some RAAs can be associated with calcifications, which may lead to misdiagnoses as renal calculi, which are then mistakenly treated.Case presentationA 69-year-old female patient was admitted to the hospital with no discomfort and was diagnosed with a large right renal calculus. The ultrasound and computed tomography urography (CTU) scan suggested a large calculus in the right pelvis with hydrops of the kidney. Therefore, we chose percutaneous nephrolithotomy (PCNL) to treat the right renal calculus, but no calculi were found in the renal pelvis. When we removed the mucosa of the renal pelvis with a holmium laser, we observed a fluctuating unruptured aneurysm with calcification. Therefore, the previous diagnosis of a renal calculus was disregarded. The operation was stopped immediately, and then computed tomography (CT) angiography was performed, confirming the right renal aneurysm with calcification. Then, Renal artery aneurysm (RAA) coil embolization was performed. After a long-term follow-up, the patient recovered well.ConclusionsThe RAA of this patient had calcific changes, which led us to errors in the diagnosis. Hence, it is very important for surgeons to effectively distinguish between renal calculi and aneurysms with ring-like calcifications. Our case report looks back at the thrilling situation during the operation and advises surgeons on how to deal with this situation properly.

Renal angiomyolipomatosis and bleeding aneurysms in a tuberous sclerosis context: selective artery embolization in a girl with end-stage renal failure.

Recent developments in endovascular radiological techniques and devices have rendered embolization a major therapeutic option prior to surgery in many renal vascular or neoplastic diseases. A 19-yearold female patient, with a diagnosis of tuberous sclerosis complex (TSC) in childhood, was admitted with severe anemia. Polycystic kidney disease in end-stage renal failure appeared four years before and the patient has been undergoing peritoneal dialysis. The patient’s medical history also included bilateral renal angiomyolipomas (AMLs). One year earlier, a unilateral endovascular embolization was performed to repair a bleeding aneurysm at the right renal upper pole. A second bilateral ruptured renal aneurysm was diagnosed at admission. To continue with peritoneal dialysis and prevent intrarenal hemorrhage and intraperitonal bleeding, an urgent bilateral renal AE was performed. Two months later she underwent a bilateral retroperitoneal nephrectomy. The posterior surgical approach, preserved the peritoneal surface area and adequate conditions to continue dialysis. At histology, bilateral AMLs were confirmed and a renal cell carcinoma of the right kidney was concurrently discovered. She undergoes continuous peritoneal dialysis. Urgent selective renal AE represents a feasible treatment for bilateral AML bleeding. It is safe and feasible before performing nephrectomy in patients with end-stage renal failure.

Renal artery aneurysm

Renal artery aneurysm (RAA) is a rare presentation, accounting for <1% of all splanchnic aneurysms. Renal aneurysms may present as hypertension, flank pain, hematuria, or with signs of rupture, but are often asymptomatic. We are hereby presenting one such case that we encountered in our clinical practice. A 67-year-old male diagnosed incidentally with left RAA 2.5 cm in size, without any local or systemic complications, underwent open repair with interposition vein graft repair and had an uneventful postoperative course.

Renal artery aneurysm at a Nigerian tertiary centre: Case report and review of literature.

Renal artery aneurysms are rare urologic conditions, with rupture being the most feared complication. We discuss the management of two women with this disease at our center. The first was a 58-year-old woman who presented with torrential hematuria and hemodynamic compromise. Abdominal computed tomography (CT) angiography revealed a left renal artery aneurysm, and she had emergency nephrectomy. The second was a 40-year-old woman with recurrent flank pain of 2 years duration. Serial CT scans showed a calcified renal aneurysm remaining stable over this period. She was managed nonoperatively, with serial follow-up imaging to determine if future intervention is warranted. We conclude on the need for adequate evaluation and imaging to promptly diagnose renal artery aneurysms, and that care should be individualized.

TWO CASES OF THE CALCIFIED RENAL ARTERY ANEURYSM. DIFFERENTIAL DIAGNOSIS AND TREATMENT (OWN EXPERIENCE)

Renal artery aneurysm is defined as the dilated segment of renal artery exceeding twice the diameter of the normal renal artery. As more than half of such aneurysms have the annular calcification, they must be differentiated from the stones. Differential diagnosis of the renal artery aneurysm includes the parapelvical cysts, hydronephrosis and kidney tumors. Renal artery aneurysm can be diagnosed by CT, MRI, as well by ultrasonography and color dopplerography. Unfortunately presence of calcification renders the ultrasonographic examination impossible. In this article we share our own experience of two cases of calcified renal aneurysms diagnosed and treated at our hospital.

Double-Lumen Balloons, Are They Only Useful in Neurointerventions? Preliminary Outcomes of Double-Lumen Balloon-Assisted Embolization of Visceral Artery Aneurysms.

This study aimed to assess the feasibility and results of double-lumen balloon-assisted embolization of visceral artery aneurysms (VAAs). Nine patients (mean age, 55.3 ± 10.8 years) diagnosed with VAA (superior mesenteric, n = 5; splenic, n = 2; renal, n = 2) and undergoing double-lumen balloon-assisted embolization were included in this study. Magnetic resonance angiogram (MRA) was used in the 6-month follow-up to assess the aneurysms and patency of the parent arteries. All patients were successfully treated with no reports of morbidity or mortality. Residual filling of the aneurysm neck was detected in 2 patients at the end of the procedure, but those parts were found to be stable in the sixth-month MRA. In 1 patient with renal aneurysm, a stent had to be deployed using a double-lumen balloon catheter because of the prolapse of the coil into the main artery. In another patient with a very large-necked superior mesenteric artery aneurysm, additional coils could be used at the same time thanks to the double-lumen balloon as the coils were not stabilized enough during embolization with the microcatheter coils. Liquid embolic agent was also used in this patient from the same lumen because of the large diameter of the aneurysm. Double-lumen balloons, which are mostly used in neurointerventional procedures, can be efficiently used as in the treatment of VAAs due to their ability to deploy stent and perform coil-liquid embolization through 1 lumen.