Rupture Of Renal Artery Aneurysm Research Articles

Renal Artery Aneurysm Rupture as a Dangerous Mimic of Ovarian Cyst Rupture: A Case Report.

Renal artery aneurysm rupture is a rare but morbid diagnosis, often requiring emergency surgery and nephrectomy. Clinical presentation can mimic more common pathology in non-pregnant women such as ruptured ovarian cyst. We present a case of a woman with a prior history of ovarian cyst presenting with a ruptured renal artery aneurysm. Prompt computed tomography (CT) imaging revealed a left renal artery aneurysm rupture with hemoperitoneum and renal infarct. She underwent emergency laparotomy and nephrectomy and was ultimately discharged in good condition. While ovarian cyst rupture is the most common cause of spontaneous hemoperitoneum in non-pregnant women of childbearing age, renal artery aneurysm rupture should be considered and prompt CT imaging obtained, particularly in cases of hemodynamic instability, to ensure prompt treatment.

Renal Artery Aneurysms in the Inpatient Setting

The risk of rupture of renal artery aneurysms (RAAs) remains undefined. A recent paper from the Vascular Low-Frequency Disease Consortium (VLFDC) identified only 3 ruptures in 760 patients. However, over 80% of patients in the VLFDC study were treated at large academic centers, which may not reflect the pattern of care of RAAs nationwide. Thus, the purpose of this study was to evaluate the pattern of nonelective versus elective surgery requiring inpatient admission for RAAs, including nephrectomies, and their outcomes using a national database. The National Inpatient Sample (NIS) database from 2012 to 2018 was utilized. Patients with a primary diagnosis of RAAs were identified using ICD-9 and ICD-10 codes. Ruptured RAAs (rRAAs) were identified utilizing surrogate ICD codes. The primary outcome variables for this study were proportion of RAAs requiring non-elective surgery and in-hospital mortality. A total of 590 inpatient admissions for RAA were identified with 554 procedures at 467 hospitals across the country. Of the 590 inpatient admissions, 380 (64.4%) admissions were deemed nonelective. There was an increasing proportion of nonelective admissions over the study period. The overall rate of nephrectomies was 7.1% (n=42). In-hospital mortality rate for the cohort was 1.4% (n=8) with no differences in in-hospital mortality in the elective versus nonelective setting (1.0% vs. 1.6%; P=0.718). In the nonelective setting, patients requiring a nephrectomy (n=23) had significantly higher rates of in-hospital mortality compared those not requiring a nephrectomy (8.7% vs. 1.1%, P=0.045). rRAA (n=50) patients had significantly higher in-hospital mortality compared to the remainder of the cohort (6.0% vs. 0.9%, P=0.024). rRAA patients were also more likely to undergo a nephrectomy compared to the remainder of the cohort (16.0% vs. 6.3%, P=0.019). These data demonstrate that treatment of RAAs are primarily done in the nonelective setting with a high proportion of ruptures, which could continue to rise as the threshold for repair has decreased.

A case of retroperitoneal hematoma and hemorrhagic shock caused by spontaneous intraparenchymal renal artery aneurysm rupture

article: A case of retroperitoneal hematoma and hemorrhagic shock caused by spontaneous intraparenchymal renal artery aneurysm rupture - Italian Journal of Emergency Medicine 2021 December;10(3):165-7 - Minerva Medica - Journals

A Rare Case of Fibromuscular Dysplasia with Postpartum Renal Artery Rupture in a Non-Hypertensive Woman

Fibromuscular dysplasia (FMD) of the renal artery is a non-atherosclerotic, non-inflammatory vascular disease that causes stenosis, aneurysm, dissection, and occlusion of the vessel. We report a rare case of a postpartum FMD patient who presented with spontaneous acute perirenal hematoma due to renal artery aneurysm rupture after cesarean section. The 40-year-old patient presented with sudden onset of abdominal pain 2 days after an elective cesarean section performed at full gestational term. A computed tomography scan of the abdomen revealed perirenal hematomas with signs of FMD in both renal arteries. The bleeding was successfully controlled by transcatheter arterial embolization. Short-term continuous renal replacement therapy was performed until her renal function recovered. FMD of the renal artery is rare in pregnant patients. Additionally, aneurysm rupture can be life threatening and requires immediate medical attention and prompt management.

Rupture of renal artery aneurysm during cesarean section: a case report


 Introduction:
 Renal artery aneurysm (RAA) occurs to focal dilatation of artery secondary to weakness of the arterial intima and media. RAA is a rare clinical entity with an incidence of 0.01 – 1%.1
 Rupture RAA during pregnancy is extremely rare event. The obstetric and urologic literatures are deficient in this regard. Diagnosis of rupture RAA during pregnancy is very difficult i.e. no pathognomonic presentation. When rupture occurs during pregnancy the clinical presentation is confused with those more common conditions e.g. placenta abruption or rupture uterus. 
 Most of the cases are discovered incidentally, even it is only diagnosed after autopsy.
 Case presentation:
 A fifth cesarean section was done for 30 years oldwomen presented with placenta previa. She was gravida 6 para 5. Cesarean section was an elective one. She gave a live birth male weighing 2.4 kg. Hysterectomy was carried out after sever bleeding during operation. Ten units of blood were given in addition to other management steps. Urologists and general surgeon were consulted. The patient was dead. Exploration was done and revealed a rupture of left renal artery aneurysm. 
 Discussion:
 It was the 5th cesarean section for women. Literature documented that previous history of cesarean sections is the primary risk factor for developing placenta previa.1 Other risk factors are gestation with male fetuses and multiparity.3 The mentioned risk factors were characters of the reported case. It was stressed that multiple cesarean sections affect adversely the health of women.2 It was the 5thcesarean section. 
 RAA is an unusual diagnosis. Hemodynamic changes during pregnancy that is increased blood volume and cardiac output, raised intrabdominal pressure and hormonal alterations, affect the arterial wall and increased the risk of rupture RAA, more so in the 3rdtrimester.3 The reported case was gravida 6 which might enhanced the formation and rupture of RAA. It was reported that women with RAA and unusual number of women were multiparous.4
 Owing to the pregnancy state, RAA was missed as ​cesarean section was planned for delivery of acase of placenta previa. The final diagnosis made only after exploration. It is the same as mentioned in literature.5
 In this case, RAA was on the left side. Literature reported that RAA was often on the left side.4 Since 1970, published reports have not shown a left sided predominance of RAA.6
 There are no previous reports of diagnosis of the intact RAA during pregnancy. This report might be the first one in Iraqi literature of rupture of RAA during pregnancy. 
 Conclusion: The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. Imaging facilities should be available in theater rooms to be used immediately. 

Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm – case report

PurposeRenal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%).Case reportA 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation.ConclusionsThe authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm.

Cesarean section following idiopathic rupture of renal artery aneurysm leading to fetal dysfunction

BackgroundRenal artery aneurysms (RAAs) in pregnancy are uncommon, with most found after rupturing. The risk of RAA rupture increases during pregnancy and delivery.Case presentationA 29-year-old woman at 36 weeks and 5 days of gestation presented with severe back and abdominal pain. No fetal movements were identified. Cesarean section (C/S) was performed due to severe fetal bradycardia. No signs of placental abruption or abnormalities of the placenta were apparent intraoperatively, but gross hematoma was identified intraoperatively in the left retroperitoneal space. To evaluate persistent hypotension and retroperitoneal hematoma, contrast-enhanced computed tomography was performed and revealed ruptured RAA in the left kidney. Transcatheter arterial embolization (TAE) was performed.ConclusionsThis case report describes fetal dysfunction caused by RAA rupture and controlled by TAE.

АНЕВРИЗМИ НИРКОВИХ АРТЕРІЙ: ДІАГНОСТИКА ТА ХІРУРГІЧНЕ ЛІКУВАННЯ EX VIVO

Renal artery aneurysm (RAA) is a rare disease that is detected in autopsy in 0.01 – 0.09% as a casual finding. The RAA are divided into: true aneurysms (saccular or fusiform), dissecting aneurysms (from the aorta, only from renal arteries), pseudoaneurysms, intrarenal aneurysms. The causes of RAA include: atherosclerosis, fibro-muscular dysplasia, hypertension, hydronephrosis, Ehlers-Danlos syndrome. In 90% of cases, RAA manifests itself in arterial hypertension. Abdominal pain, paresis of the intestine, the presence of pulsating formation, hematuria may indicate on increase in the size of the aneurysm or their dissection. The use of ultrasound duplex scan, CT, MRI and angiography can confirm the RAA in 0.3-2.5% in high-risk groups. Indications for surgical treatment include: RAA > 2 cm, RAA in women of childbearing age, abdominal or lumbar pain, hematuria, refractory to drug therapy arterial hypertension, functionally significant stenosis of RA with size of RAA > 1cm, thromboembolism, dissection, rupture of RAA. Surgical treatment of the RAA consists of: in situ reconstruction (in-situ prosthesis, tangential resection and angioplasty, nephrectomy), endovascular interventions (aneurysm embolization, stenting), extracorporeal reconstruction – ex vivo. The autotransplantation of the kidney with extracorporeal reconstruction of the renal artery with RAA of the second and third branching is an efficient method of treatment, which provides satisfactory long-term clinical results and is performed in cases when classical reconstruction or endovascular correction is impossible.

Case Report on Ruptured Renal Artery Aneurysm

Renal aneurysms are a rare entity with an incidence of 0.09% of the population. They are often asymptomatic and frequently discovered incidentally during abdominal imaging for unrelated causes. Rupture of renal artery aneurysms is a surgical emergency, very often lethal. Swift diagnosis is crucial and is made by ultrasound and abdominal MDCT. We report the case of a renal artery rupture in a 58 year-old man who arrived in the emergency department with left flank pain of sudden onset followed by a hypovolemic shock. MDCT scan showed the rupture of an aneurysm of the left renal artery associated with a retroperitoneal hematoma. It is a life-threatening situation in case of delayed diagnosis. In our case, prompt imaging and diagnosis led to conservative treatment and nephrectomy was avoided.

Giant renal artery aneurysm rupture

An 82-year-old white male with a history of heart failure, hypertension and hypercholesterolemia was admitted to the emergency room with sudden and severe left flank pain that radiated to the back. An abdominal computed tomography (CT) scan revealed a giant saccular 8 × 7.5 cm ruptured left renal artery aneurysm (RAA) with active bleeding spreading through the peri and pararenal spaces into the left retroperitoneum (Panel A: coronal plane – maximum intensity projection (MIP); Panel B: sagittal plane). Additional findings included both an unruptured aortic abdominal aneurysm and a left common iliac artery aneurysm. Owing to evolving hemodynamic instability, the patient underwent successful emergency operative obliteration of the aneurysm with a suture ligation of the left renal artery orifice and nephrectomy (Panel C). Non-traumatic RAA is a rare disease, with an incidence ranging from 0.01% in an unselected autopsy population to 0.97% in recent studies using computed tomography and visceral angiography. Factors contributing to its formation are not well known, but atherosclerosis, fibromuscular dysplasia, polyarteritis nodosa or Ehlers–Danlos syndrome are known to be related. Atherosclerosis may be the predominant cause in elderly individuals but it is a secondary reaction from primary degeneration of the media in young people.1 Although pregnancy is not associated with an increased incidence of RAA formation, it is associated with a higher rate of rupture. Clinical manifestations of RAA vary from being asymptomatic to fatal rupture. The spontaneous rupture of RAAs is very rare since it occurs only in 3% of affected patients; however, it is the most catastrophic complication. Initial diagnostic tests typically include Doppler ultrasound and CT scan with a well-timed contrast injection. Although there has been no consensus on the treatment of asymptomatic RAAs, any patients with symptoms, those with aneurysms larger than 2 cm and women with RAAs anticipating pregnancy should be treated.2 Aneurysm exclusion, artery reconstruction and kidney preservation are the treatment goals during repair. However, in case of rupture, an emergency midline approach with infrarenal/supraceliac aortic control and nephrectomy is usually required to control hemorrhage and prevent death.3 Although the long-term results remain unclear, when feasible, endovascular treatment Images in Vascular Medicine

腎動脈エコーにより発見された腎動脈瘤の2症例（仮性腎動脈瘤，腎動脈瘤腎盂内破裂）

腎動脈エコーにより発見された腎動脈瘤の2症例（仮性腎動脈瘤，腎動脈瘤腎盂内破裂）

Rupture of renal artery aneurysm during the early post‐partum period

Rupture of renal artery aneurysm associated with pregnancy is an uncommon condition. It is known that almost all previously reported cases have occurred during pregnancy. We experienced a case of rupture of renal artery aneurysm during the early post-partum period which was diagnosed by computed tomography and treated by angiographic embolization. To our knowledge, only two cases of rupture of renal artery aneurysm during the post-partum period have been reported in the English-language published work. An early diagnosis of rupture of renal artery aneurysm during the post-partum period is very challenging because the clinical symptoms of this condition are acute abdominal, flank or back pain, which are relatively common signs caused by more common post-partum complications. However, rupture of renal artery aneurysm is a life-threatening emergency condition requiring prompt diagnosis and treatment. The possibility of a rupture of renal artery aneurysm should be considered in any pregnant women with symptoms of an acute abdomen with hemorrhagic shock.

Spontaneous Renal Artery Aneurysm Rupture in a Patient With Neurofibromatosis Type 1 Without Risk Factors for Renal Artery Aneurysm Rupture

Vascular abnormalities in neurofibromatosis type 1 (NF-1) are rare but sometimes fatal. We report a case of spontaneous rupture of a left renal artery aneurysm in a patient with NF-1. A 41-year-old nonpregnant normotensive woman known to have NF-1 presented to our emergency department with left flank pain. Computed tomography showed a large retroperitoneal hematoma due to left renal artery aneurysm rupture. She was treated with selective transcatheter coil embolization and fully recovered.

腎盂内破裂をきたした右腎動脈瘤の1例

We report a case of ruptured renal artery aneurysm into the renal pelvis. A 48-year-old woman presented with complaints of gross hematuria and right back pain. Abdominal ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the aneurysm, which was 5 x 5 cm in diameter. Enhansed CT revealed blood flow from the renal artery aneurysm into the renal pelvis. Radical nephrectomy was performed. Rupture of renal artery aneurysm into the renal pelvis is the 3rd case in the Japanese literatures. Pathogenesis and management of this rare condition are discussed.

Bilateral Spontaneous Perirenal Hemorrhage in an Acquired Cystic Kidney Disease Hemodialysis Patient

Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics.

Acute renal artery aneurysm rupture – a rare differential diagnosis of acute appendicitis

A 50-year-old patient with symptoms of an acute appendicitis turns out to be suffering of a life threatening rupture of a renal artery aneurysm. We performed an emergency operation with the resection of this aneurysm. An imminent hemorrhagic shock made a targeted intensive medical therapy necessary.

Secondary hyperaldosteronism in a patient with polyarteritis nodosa and renal artery aneurysms

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that affects medium- and small-sized arteries. We report the case of a 32-year-old female with PAN in which renal involvement was revealed by a secondary hyperaldosteronism. Hypokaliemia and arterial hypertension preceded rupture of renal artery aneurysm by several months. We believe that hyperreninemia resulted from diffuse renal necrotizing vasculitis with occlusive but non-stenotic lesions. Angiography or CT scan should be performed systematically in PAN to screen for aneurysms so as to be able to consider prophylactic treatment by embolization and intensification of the general treatment. Hyperaldosteronism may reveal renal involvement in PAN and warrants an angiography if it has not yet been done.

Successful management of renal artery aneurysm rupture after cesarean section

Renal artery aneurysm is a rare entity, and patients are usually asymptomatic at the time of presentation. These aneurysms are rare among pregnant patients, especially after childbirth, and usually form due to changes in vascular wall integrity secondary to hormonal and hemodynamic changes. Here we describe a patient with an intraparenchymal renal artery aneurysm that ruptured after a cesarean section but was immediately identified and managed appropriately, allowing for a successful outcome.

Is it renal colic or ruptured dissecting aneurysm of renal artery?: A case report

IntroductionThe dissecting aneurysm of renal artery is a form of renal artery occlusive disease that is infrequently recognized in the literature. However, when encountered, it is of great clinical significance because symptoms related to aneurysm are rarely seen and there is risk of its rupture.Case PresentationThe present case was a 30 year old Indian male, who presented with recurrent episodes of pain mimicking renal colic, which turned out to be a ruptured dissecting aneurysm of renal artery on exploration. The patient could not be salvaged due to delay in the diagnosis.ConclusionThis report highlights that rupture of renal artery aneurysm is a rare but potentially lethal clinical entity and should be considered as one of the differential diagnosis in patients with severe and persistent renal colicky type of pain in the absence of obvious findings on routine investigations.

Spontaneous renal artery aneurysm rupture: an unusual cause of abdominal pain and syncope

Spontaneous renal artery aneurysm (RAA) rupture is a rare, but potentially fatal, cause of abdominal pain. A case is reported of a ruptured RAA in a previously well 45-year-old woman...