Treatment Of Renal Artery Aneurysms Research Articles

Treatment of Renal Artery Aneurysm by ex situ Repair and Autotransplantation: A Nationwide Cohort Study

Introduction: Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aimed to investigate the safety and efficacy of ex situ repair and autotransplantation for endovascularly untreatable RAA. Methods: A retrospective nationwide cohort study was conducted in RAA patients undergoing ex situ repair and autotransplantation in the Netherlands. Surgical techniques, postoperative complications, and graft outcomes were assessed. Results: Ex situ repair was performed in 9 patients with 11 RAAs. Eight RAAs were located at the first bifurcation, one on the main trunk, one on the first branch, and one on the second branch. Nephrectomy was performed via laparoscopy (n = 7), robotic-assisted laparoscopy (n = 1), and laparotomy (n = 1). Postoperative complications were recorded in 4 patients, including bowel obstruction, delirium, pneumonia, and hydronephrosis due to double-J dislocation. The median estimated glomerular filtration rate was 83 mL/min/1.73 m2 pretransplant and 88 mL/min/1.73 m2 posttransplant. By an average follow-up of 32 months, 2 patients had died due to lung adenocarcinoma and stroke, while all autotransplanted kidneys had good patency and remained functional. Conclusions: Ex situ repair and autotransplantation are safe and feasible for endovascularly untreatable RAA cases. Larger cohorts with longer follow-up periods are necessary to further evaluate the role of this surgical approach.

Trans-catheter procedures in the management of renal artery aneurysm

Background The endovascular approach has emerged as the preferred method for managing renal artery aneurysms (RAAs), particularly in cases with intricate anatomical features, as a viable alternative to surgical intervention. Aim The objective of this research was to assess the significance of trans-catheter operations in the treatment of RAAs, with a particular focus on the management of symptoms. Patients and methods This prospective minimally invasive was carried out on 30 patients with RAA aged from 6 to 67 years old, diagnosed by various radiological modalities (ultrasonography, computed tomography, or MRI) and underwent 30 arteriographies for RAA who were managed by Trans-catheter procedures (especially selective embolization with coils). All patients undergo follow-up by clinical assessment, medical imaging, and laboratory investigations. Results Out of the total 28 RAAs that were treated, a significant majority of 93.3% were effectively embolized and showed no symptoms of recurrence during the subsequent follow-up period. One case (3.3%) of RAA did not achieve effective embolization, resulting in failed embolization. Additionally, another case (3.3%) of RAA had recurrence during follow-up despite initial successful closure. Minor issues occurred in seven instances, accounting for 23.3% of the total occurrences, while significant complications were observed in only one instance, representing 3.3% of the total occurrences. Conclusions The endovascular approach is a very safe and successful method for managing RAAs, whether in planned or emergent medical scenarios. This approach preserves renal function and minimizes invasiveness, while also demonstrating low rates of both severe and minor complications.

Open reconstructive surgery for renal artery aneurysm

THE OBJECTIVE was to evaluate the immediate results of open reconstructive operations for renal artery aneurysm.METHODS AND MATERIALS . From March 2019 to September 2023, 55 patients with visceral artery aneurysms were operated at the Department of Vascular Surgery at the Pavlov University. 4 patients with renal artery aneurysms were operated on by open surgical method and 5 patients underwent endovascular operation. There are two clinical cases of open reconstruction of renal artery aneurysm in situ and one ex vivo. In all cases, the indication for the operation was the presence of a symptomatic aneurysm. For in situ reconstructions, a retroperitoneal thoracophrenopararectal access to the tenth intercostal space on the left side with the opening of the left pleural cavity and partial diaphragmatic cavity and a transverse laparotomy of «chevron» type were used. Autovena was used as a bypass. For surgery of the renal artery ex vivo laparoscopic nephrectomy with autotransplantation of the kidney was performed. In the near postoperative period, we made the assessment of the patency of the reconstruction zone using MSCT angiography, the analysis of indicators of renal function.RESULTS . All the observations noted satisfactory near-term results – the reconstruction zone is unobstructed, indicators of renal function without negative dynamics, absence of clinical manifestations of this pathology. Long-term results (observed for more than 4 years) were traced in one patient. During this period, normal renal function and adequate functioning of the reconstruction zone are maintained.CONCLUSION . Open reconstructive surgery in the surgical treatment of renal artery aneurysm remains relevant due to the inability in some cases to perform its endovascular correction without high risk of ischemic damage to the parenchyma of the kidney.

Kidney autotransplantation for multiple renal artery aneurysms: A case report

Kidney artery aneurysms are a rare phenomenon with a prevalence of 0.01%-1% in the general population. Although historical series describe rupture rates of 14% to 30% with a mortality rate of 80%, the natural history of kidney artery aneurysms is currently characterized by a low risk of rupture and a slow to nonexistent growth rate. Criteria for repair have been controversial for decades and currently include aneurysm size > 2 cm, female sex, and symptoms such as drug-refractory hypertension, pain, and hematuria. In this article, we report a successful kidney autotransplantation for multiple renal artery aneurysms (8 to 9 mm) in a 37-year-old woman who had suffered from arterial hypertension for 19 years. The clinical case described demonstrates the efficacy of surgical treatment of renal artery aneurysms with malignant hypertension.

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.

Multimodal Repair of Renal Artery Aneurysm – 10-year Single Center Experience

Renal artery aneurysm (RAA) is a rare disease with various treatment options in indicated patients. In the current survey, the 10-year experience in treatment of RAAs using different endovascular and surgical treatments depending on RAA characteristics is discussed. All patients undergone RAA treatment via endovascular or surgical approaches at our center between January 2010 and December 2020 were enrolled. Patient demographics and peri-operative and late results were collected from a prospectively maintained database. Eleven patients with RAA underwent treatment as follows: 4 patients received endovascular approach, 4 patients underwent in-situ RAA repair, and kidney autotransplantations were carried out in 3 patients. In all three treatment groups, the first therapeutic attempt was successful and none of the patients underwent secondary intervention due to RAA. Kidney autotransplantation was associated with a higher blood loss and a longer time of procedure compared to that of endovascular approach and in-situ repair. In-hospital postoperative complications were reported in 5 patients, including renal pole perfusion defect, renal artery thrombosis, and urinary tract infection. No acute kidney organ loss was seen, but 1 patient suffered from chronic kidney loss due to renal artery occlusion. In 1 patient undergoing autotransplantation, ureter anastomosis was reported, which led to acute renal failure, and a surgical treatment with resection and reanastomosis of the ureter was necessary. Hypertension was not resolved after RAA repair in any of the patients with preoperative hypertension. RAA treatment selection depends on patient characteristics, anatomy, location, and arising branches of the aneurysm. In cases with complex anatomy, treatment strategy could not be just decided based on consensus guidelines, but a multidisciplinary team is required. Interventional therapies showed excellent results in non-complicated proximal aneurysms, especially regarding the length of hospital stay and postoperative morbidities. Open surgery is a complementary alternative in cases where minimally invasive therapy is not possible. Ex-situ repair with autotransplantation could be considered for anatomically complex distal aneurysms.

Renal Autotransplantation for The Treatment of Renal Artery Aneurysm

Renal artery aneurysms are a rare condition; however, the rate of diagnosis has been increasing, because of the increasing use of complementary diagnostic methods. The best treatment strategy for RAAs remains controversial. Data on ex-vivo surgery associated with kidney autotransplantation are scarce. As a result, the goal of this study was to describe this technique and to report our results. A retrospective monocentric study was undertaken using the clinical records and images of 35 patients diagnosed with renal artery aneurysm from 01/01/2010 to 31/12/2018. Indications for ex vivo surgery and autotransplantation were complex aneurysms with diameter >20 mm or rapid growth or symptomatic aneurysms or women wishing to become pregnant. Complex aneurysms were defined by anatomical criteria (bifurcation of the renal artery and its primary branches or hilar aneurysms) and/or physiological criteria (when time of warm ischemia in in-situ reconstruction is expected to last more than 45 minutes). The technique of ex-vivo surgery and autotransplantation consists of performing a nephrectomy, renal cooling, treatment of aneurysm in banking and implantation of the kidney in the homolateral iliac fossa. A total of 35 patients with 56 renal artery aneurysms (26 women, mean age 52.4 years-minimum and maximum 16 and 74 years) were included. Of these, 27 were treated by surgery and 8 were followed clinically. Among those treated surgically, 24 performed ex vivo surgery associated with autotransplantation. Regarding ex vivo surgery, nephrectomy was performed by laparoscopic surgery in 24 of the 27 surgeries, the mean surgical time was 5.3 hours, the median warm ischemia time was 4 minutes and the length of hospital stay was 12.2 days. Mortality was 0% and the kidney patency rate was 93% with a follow up of 47.2 months. Of the 17 patients with hypertension, 6 cured it, 4 improved and 7 maintained hypertension. Kidney autotransplantation appears to be efficient for most complex RAA with the possibility to minimize surgical aggression by performing laparoscopic nephrectomy.

Single Centre Experience in Open and Endovascular Treatment of Renal Artery Aneurysms

Background: The true incidence and natural history of renal artery aneurysm (RAA) remain unclear and still exists controversy over indication for treatment. Several techniques of conventional surgical reconstructions are described in literature, and more recently endovascular therapies have been reported with satisfying results and lower complication rate. This paper aims to investigate the outcomes of both endovascular and open repair of RAA achieved in a single institution involving 3 medical teams (urology, vascular surgery and neuroradiology). Material and Methods: We conducted a single-centre retrospective observational study about all patients surgically or endovascularly treated for RAA over a 15-year period. Pre-operative, procedural and post-operative data at the early, mid- and long-term follow-up were collected and analysed, focusing on operative technique used for repair and related outcomes. Results: A total of 27 patients (n = 17 (63%) women, mean age 58 ± 13.2, n = 26 saccular RAA) were included. Mean aneurysm was size was 18.8 ± 6.3 mm. Most diagnosis were accidental. Symptomatic RAA showed with macroscopic haematuria (n = 3, 25.9%), unstable hypertension (n = 2; 7%), chronic lumbar pain (n = 1, 3.7%) and renal infarct (n = 1, 3.7%).Conventional surgery (ex-vivo repair, aneurysmorraphy, aneurysm resection and end-to-end anastomosis) was performed in 14 (51.8%) cases and endovascular coiling embolization in 13 (48.2%). Mean hospital length of stay was 5.4 ± 3.6 days. Intensive Care Unit stay was needed only in the surgically treated patients (mean 1.1 ± 1.2 days). During the early follow-up, morbidity rate was 7/14 in surgically treated patients vs. 1/13 in endovascular group; it included bleeding, retroperitoneal hematoma, arterial thrombosis and bowel obstruction. The discharge imaging showed complete aneurysm exclusion and renal artery patency in all cases.At a mean follow-up of 39 ± 42 months, 3 patients (11%) were lost to follow up and 2 (7.4 %) died from unrelated cause. None of these patients required dialysis but a statistically significant (P = 0.09) decrease in GFR was noted between the preoperative period and last follow-up control. RAA repair neither showed blood pressure control improvement nor reduced the need for anti-hypertensive drug use. Conclusion: Open or endovascular techniques are both safe and efficient to treat RAA. Even though, surgical management is burdened with higher morbidity rate, the operative technique should be selected according to anatomical features, diameters and location of RRA; and the number of renal branches involved. Further larger studies are needed to define the feasibility and safety for a wider application of the endovascular approach.

Abstract No. 450 Endovascular treatment of renal artery aneurysms: a single-center experience

Renal artery aneurysms (RAA) represents a rare and potentially life-threatening condition with a documented incidence of 0.09% of the general population. Endovascular treatment for RAA is becoming widely accepted over open surgical repair due to decreased morbidity and comparable mortality. We report safety and efficacy of endovascular treatment of RAA. A single-center retrospective review of all endovascular treatment of RAA from November 2008 to September 2019 was performed. Eleven RAA (81.8% F, age 58.4) were identified (Table). Procedural and clinical details, aneurysm characteristics, and outcomes were recorded. Technical success, defined as complete aneurysm exclusion with preservation of renal function (no change in GFR/Cr), 30-day mortality rate, minor and major adverse events (following the Society of Interventional Radiology Clinical Practical guidelines), and re-intervention rates were recorded. The mean follow-up period was 23 months (range, 1–130). Technical success rate was 100%. No re-intervention was required. One 30-day mortality was reported (9%), likely due to the patient’s underlying stage IV renal cell carcinoma and unrelated to intervention. No significant changes in renal function was seen. One minor adverse event was recorded, which was attributed to renal infarctions < 50% without elevation in baseline GFR. Endovascular treatment of RAA is associated with high technical success rates and comparatively low major AEs.Tabled 1Baseline Demographics and Clinical and Procedural CharacteristicsAneurysm (n = 11)Age, mean (SD)58 (16.5)Gender, n, (%) Male1 (10) Female10 (82)Race White4 (36) Black3 (27) Asian1 (9) Hispanic or Latina0 (0) Other2 (18) Unknown1 (9)BMI, kg/m2, mean (SD)31.33 (8)Aneurysm location or site Left renal7 (64) Right renal4 (36)Size (cm)1.5 (0.8–2.9)Aneurysm (n = 11)Embolization agent, n (%) Coils5 (45) Glue2 (18) Stent-assisted coiling3 (27) Balloon-assisted coil1 (9)GFR, pre-embolization60GFR, post-embolization60Creatinine, pre-embolization0.84Creatinine, post-embolization0.89Technical success11 (100)Complications Major0 Minor1 (9)30-day mortality rate1 (9) Open table in a new tab

Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes.

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.

Direct Distal Renal Artery Aneurysm Repair

Treatment of renal artery aneurysms (RAA) remains controversial. Endovascular treatment has increased for main trunk and for very distal aneurysms, whereas for lesions located at the bifurcation surgical treatment seems to be a valid option. The goal of this study was to describe the technique of direct reconstruction of RAA and to report on outcomes. This study comprised single centre prospective collection of data with retrospective analysis (January 2015 to August 2018) of patients operated on for distal RAA using direct reconstruction. A total of 24 RAA in 21 patients (seven men and 14 women, mean age 59±13 years) was included. History of hypertension was found in 15 patients and renal insufficiency was present in one. Mean pre-operative systolic and diastolic blood pressures were 134±21mmHg and 74±10mmHg, and mean pre-operative rates of creatinine and glomerular filtration rate were 67±13μmol/L and 93±49mL/min/1.73m2, respectively. Indications for repair were a diameter >20mm in seven cases (mean diameter=25±2mm) or rapid growth in one case, symptomatic aneurysm in 12 cases (hypertension, haematuria, pain), and a concomitant lesion in four cases (splenic aneurysm, abdominal aortic aneurysm, occlusive visceral artery lesions). All lesions were distal, main artery bifurcation in 22 cases and hilar in two cases. The main aetiology was fibromuscular dysplasia (16 cases) followed by atherosclerosis (seven cases) and one case of Ehlers Danlos Syndrome. In situ reconstruction was possible for 22 RAA, while two cases required kidney autotransplantation. The mean renal ischaemia time was 18±5min. At two years, the patency rate was 100%, and mean systolic blood pressure decreased (134mmHg-122mmHg, p=.047). Renal function was stable from 93±49 pre-operatively to 95±35mL/min/1.73m2 in the post-operative course (p=.56). Direct reconstruction appears to be efficient for most RAA. This technique is complementary to exvivo autotransplantation and endovascular treatment.

Think twice before stent insertion for renal artery aneurysm with elusive etiology: a case report

BackgroundEndovascular treatment has been recognized as the first line therapy for renal artery aneurysm (RAA). However, RAA related with malignancies had been sporadically reported in the literature. Stent insertion should be contraindicated for RAAs with malignant etiology, whereas surgery be optimal.Case presentationA 40-year-old female underwent covered stent insertion to exclude the left RAA for suspected Takayasu arteritis in a reginal hospital. Three months later the RAA recurred with sign of threatened rupture, and the patient was transferred for salvage embolization with coils and thrombin injection. However, 20 days after the embolization procedure, multiple painful subcutaneous nodules developed in her flanks. Undifferentiated sarcoma was revealed by the pathological biopsy of the nodules. The RAA in this case was most likely related with the malignancy.ConclusionMalignancy was the most likely etiology behind recurrent aneurysm in this case. Definite diagnosis is mandatory for interventional radiologists before stent insertion for treatment of RAA.

Feasibility and long-term effectiveness of endovascular therapy for renal artery aneurysms: a retrospective analysis of cases done over 1 year

Introduction True renal artery aneurysms (RAAs) are uncommon, and their actual prevalence is unknown. The indications for treating RAAs include symptomatic aneurysms, larger than 20 mm or enlarging aneurysms during follow-up, aneurysms in patients in childbearing age or in pregnant women, ruptured aneurysms, false aneurysms, and aneurysms associated with arteriovenous fistulas or dissection. Aim This retrospective study describes our experience with the endovascular treatment of RAAs with special consideration given to the indications, technical considerations, and complications. Patients and methods Endovascular therapy techniques were offered to selected patients with RAAs presented at Vascular Surgery Department, Cairo University Hospitals, between December 2017 and December 2018. Results During the study period, five patients diagnosed with RAAs were selected for endovascular therapy. Their age range was 35–57 years (mean, 46 years). From the five patients (four males and one female), three patients with RAAs (two true and one false aneurysm) underwent coil embolization, whereas two patients (one female and one male) with true aneurysms underwent stent graft therapy. The average length of postoperative hospital stay was 4.0 days. Technical success was achieved in all patients. Perioperative morbidity was not observed in any patients, and there were no postoperative mortalities. No evidence of growth of the aneurysm sac or endoleak was observed during follow-up in any patient. Conclusion Current data support the high safety of endovascular treatment of RAAs with all of its available techniques.

Effectiveness of Stent in the Treatment of Renal Artery Aneurysm using FSI Simulation

Effectiveness of Stent in the Treatment of Renal Artery Aneurysm using FSI Simulation

Діаґностика та хірурґічне лікування аневризм ниркових артерій

Aim.&nbsp;Improvement of diagnosis and surgical treatment of renal artery aneurysms.&nbsp; Material and Methods. The features of the clinical course, diagnosis and surgical treatment of renal artery aneurysm were analyzed in a 55-year-old patient. Results and Discussion.&nbsp;In our observation, in a 55-year-old patient, by clinical examination, laboratory and diagnostic imaging the following diagnosis was confirmed: Atherosclerosis. Aneurysm of the right renal artery. Moderate ectasia of the left renal artery trunk. Condition after stent-graft implantation into the right renal artery (25.06.2018), embolization of a pseudoaneurysm of the right renal artery (22.11.2018). Arterial hypertension, Stage II, risk 4. Presence of a drug-resistant hypertension, a saccular renal artery aneurysm with 2.0 cm in diameter, and unsuccessful attempts to use endovascular methods of treatment have become direct indications for surgical intervention, not only saving patient's life, but also preventing the development of fatal complications. Surgical treatment of the renal artery aneurysms consists of: endovascular interventions (aneurysm embolization, stenting), in situ reconstruction (in-situ prosthesis, tangential resection and angioplasty, nephrectomy), extracorporeal reconstruction - ex vivo. Nephrectomy is recommended in cases of multiple large intrarenal aneurysms, concomitant renal pathology (atrophy, tumor), rupture of aneurysms in patients in a shock condition, and previously unsuccessful reconstructive interventions. Conclusions.&nbsp;Renal artery aneurysm is a rare clinical condition that may be complicated by rupture and fatal bleeding. This clinical case demonstrates that adequate surgical treatment - resection of sac-like aneurysm in vivo allowed not only to prevent the occurrence of life-threatening complications, but also to achieve complete recovery of the patient.

Surgical Treatment of Renal Artery Aneurysm

Surgical Treatment of Renal Artery Aneurysm

Role of heterotopic kidney auto-transplantation for renal artery aneurysms.

To assess the applicability and surgical outcomes of ex vivo repair with heterotopic kidney auto-transplantation (HKA) for the treatment of renal artery aneurysms (RAA).We retrospectively examined 36 cases presenting with RAA from September 2005 to June 2016. Patient demographics, estimated glomerular filtration rate (eGFR), and common vascular risk factors were evaluated. Patients were classified into 3 groups: those who received endovascular treatment, in situ open surgical repair, or ex vivo repair with HKA. The findings were compared among the groups.The endovascular repair, in situ open repair, and ex vivo repair with HKA groups included 14, 9, and 13 patients, respectively (mean follow-up, 30.42 ± 30.54 months). The eGFR (P = .32) and number of anti-hypertension medications (P = .33) did not significantly differ among the groups. Moreover, 3 renal infarctions were detected in the endovascular group and only 1 was detected in the in situ repair group. One patient in the endovascular repair group required dialysis due to renal failure. Patients in the ex vivo repair with HKA group did not exhibit any complications.With safety and effectiveness comparable to other RAA treatment methods, ex vivo repair with HKA for RAA treatment appears suitable particularly in cases with complicated renal artery branch aneurysm and marginal renal function.

Coil embolization of renal artery bifurcation and branch aneurysms with flow preservation

ObjectiveCoil embolization is one of the most common endovascular approaches to treatment of renal artery aneurysms (RAAs). The purpose of this retrospective study was to compare complications, mortality, and morbidity associated with sac packing, coil trapping, and inflow occlusion. MethodsThe records of all patients with RAAs treated with coil embolization at our center from June 2003 to May 2017 were retrospectively reviewed. Demographics of the patients, aneurysm characteristics, management strategies, perioperative and long-term outcomes, and complications were analyzed. ResultsA total of 52 patient records were reviewed; 28 patients received sac packing and 24 patients underwent coil trapping/inflow occlusion. There was no significant difference in patients' demographics or RAA characteristics between the groups. The mean aneurysm diameter was 25.6 ± 8.4 mm in the sac packing group and 31.1 ± 16.8 mm in the coil trapping/inflow occlusion group (P = .130). Most aneurysms in the sac packing group originated from the main renal artery bifurcation (67.9%), whereas in the coil trapping/inflow occlusion group, most aneurysms originated from the renal segmental branch arteries (54.2%). The immediate technical success rate was 100%, and the in-hospital mortality rate was 0% in both groups. Sac packing was more likely to be associated with endoleak immediately after the procedure (28.6% vs 8.3%; P = .065). The overall perioperative complication rate was not statistically different between the groups (7.1% vs 16.7%; P = .284). The mean duration of follow-up was 37.67 ± 29.84 months and 49.35 ± 28.11 months in the sac packing and coil trapping/inflow occlusion groups, respectively (P = .192). No deaths related to RAAs or aneurysm rupture occurred in either group. The overall morbidity rate was similar between groups (12.5% vs 25%; P = .284). Partial renal infarction occurred in two and five patients in the sac packing and coil trapping/inflow occlusion groups, respectively (8.3% vs 25%; P = .132). Impaired renal function was more frequent after coil trapping/inflow occlusion (0% vs 15%; P = .049). A single patient in the sac packing group required further intervention for reperfusion of the aneurysmal sac at 4 months (4.2% vs 0%; P = .356). ConclusionsSac packing might be a safe and effective way to treat RAAs located at the main bifurcation or in branch arteries and may be preferable to coil trapping/inflow occlusion, considering the potential loss of functional renal mass.

Symptomatic hilar renal artery aneurysm mimicking renal colic - a word of caution

An adequate and timely diagnosis is crucial in the treatment of renal artery aneurysms during pregnancy since the risk of rupture and its catastrophic consequences are high. Clinical symptoms, laboratory results, and B-mode abdominal ultrasonography may mimic renal colic. In this report, a case of a pregnant 26-year-old woman with a large, symptomatic renal aneurysm is presented. The diagnostic pathway and the treatment are described. Potential pitfalls in the diagnosis are discussed.

Case Report: Treatment of Renal Artery Aneurysms by Ex Vivo Renal Artery Aneurysm Repair and Transplantation

BackgroundRenal artery aneurysms are increasingly being detected incidentally during diagnostic imaging using magnetic resonance imaging, computed tomography, or angiography performed for evaluation of other diseases. Our understanding of their natural history and surgical management has evolved significantly during the past two decades. Patients and MethodsThree patients with incidentally identified renal artery aneurysms have been referred to our renal transplantation program in the last 3 years. All three had aneurysms located at renal artery branches making endovascular repair challenging and thus underwent hand-assisted laparoscopic nephrectomy with ex vivo aneurysmectomy, with heterotopic autotransplantation in two cases and allotransplantation in the third case. ResultsAll three cases resulted in successful renal artery aneurysm repair and reimplantation and good renal function of the implanted kidney. ConclusionsLaparoscopic nephrectomy with ex vivo aneurysm repair and reimplantation can be a successful approach to surgical management, especially in cases where the aneurysm involves multiple artery branches and endovascular repair is challenging. Given the excellent results with this surgical approach, living and deceased donor kidneys with aneurysms should be strongly encouraged if deemed reparable.