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Conventional surgical repair of PAAAs can be performed with acceptable short-term and long-term mortality. Although pARF is frequent, chronic hemodialysis at discharge is rare. Cardiac and respiratory complications are also common and associated with worse survival. Our data represent a potentially useful benchmark for complex endovascular repairs of this type of aneurysm.

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The renal artery aneurysms (RAAs) represent 3% of all visceral aneurysms. Their incidence rate is about 0.1% in the general population [1], even if angiographic findings report a little higher incidence (0.3-2.5%) [2] with a modest prevalence in female patients. RAAS are mainly detected in the sixthseventh decade, and female patients are associated with an earlier incidence [3]. True RAAs are extra-parenchymal in 90% of cases, while intraparenchymal RAAs represent 10% of cases, and they are often multiple and congenital. RAAs can be saccular in 75% of cases or fusiform. Saccular RAAs usually affect the main renal artery bifurcation, while fusiform aneurysms often involve the main arterial trunk [4]. RAAs can be bilateral (10-20%) or associated with a multiple location. High calcifications are detected in 18-68% of cases [1]. HRAAs represent a rare subgroup of RAAs, located in the distal part of the renal artery, very close to the renal hilum even though they are considered extra-parenchymal (Fig. 12.1). In addition to "true aneurysms," the main renal arteries and their collaterals can be affected by:

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Purpose: Common femoral artery (CFA)-occlusive disease has traditionally been treated with open surgery, yet nowadays the frailty of patients has induced to find new techniques of revascularisation by endovascular means. So far, intravascular lithotripsy (IVL) has shown promising results in several lower limbs arterial districts. The purpose of this article is to report our experience with IVL for severely calcified peripheral arterial disease (PAD) of the CFA. Methods: From November 2018 and October 2020, 10 consecutive patients (12 limbs) treated with IVL were prospectively enrolled in a dedicated database. Inclusion criteria were CFA localization of PAD, with a severe degree of calcification, a lesion length ≥10 mm, and a degree of stenosis ≥70% (severe). The only admitted adjunctive treatment was drug-coated balloon (DCB) angioplasty. Primary outcomes were technical and procedural success, clinical success, and target lesion revascularisation (TLR). Secondary outcomes were target extremity revascularisation (TER) and major adverse events (MAEs). Results: All patients underwent IVL with associated DCB angioplasty. The median percentage of achieved stenosis reduction was 55.5% (interquartile range [IQR] 50-60.75), with a technical and procedural success of 100%. Over the study period, TLR only occurred in one limb (8.3%), with a mean upgrade in Rutherford class of 2.7 ± 0.77. No target vessel and access site complications were reported, as well as no distal embolization. One death and one major amputation occurred over the follow-up period, both in the same patient. Conclusions: Based on our experience, IVL for selected cases of severely calcified CFA disease, associated with DCB angioplasty, may be considered a safe and effective technique. Of course, a long-term follow-up and a larger series of patients are needed to validate our results.

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