A renal artery aneurysm is defined as a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery. Although rare, the diagnosis and incidence of this entity have been steadily increasing due to the routine use of cross-sectional imaging. In certain cases, renal artery aneurysms may be clinically important and potentially lethal. However, knowledge of their occurrence, their natural history, and their prognosis with or without treatment is still limited. This article aims to review the recent literature concerning renal artery aneurysms, with special consideration given to physiopathology, indications for treatment, different technical options, post-procedure complications and treatment outcomes.

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E 4 4 9What ' s known on the subject? and What does the study add? The surgical implications of renal cell carcinoma with coexisting bland and tumour thrombi of the inferior vena cava is not well described. In this study we review our experience managing these tumours. On multivariate analysis, we found that the presence of bland thrombus was associated with an increased need for surgical interruption of the inferior vena cava. OBJECTIVE• To study the role of interruption of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC) and associated bland and tumour thrombi. METHODS• We reviewed 129 consecutive patients with the preoperative diagnosis of RCC with tumour thrombus who underwent radical nephrectomy and tumour thrombectomy in one academic institution between May 1997 and February 2011. RESULTS• Percentages of patients with levels I, II, III and IV tumour thrombus were 29%, 13%, 48% and 9%, respectively.• The perioperative mortality rate was 2.3%. There were 29 (22%) perioperative complications recorded.• In all, 19 patients underwent surgical interruption of the IVC by ligation or segmental resection, including one level II, 14 level III and four level IV thrombi.• A total of 15 patients (12%) had bland thrombus associated with the tumour thrombus; four of these underwent intraoperative IVC fi lter placement and eight underwent surgical IVC interruption.• Advanced level of tumour thrombus was the only signifi cant factor predicting association of bland thrombus (odds ratio [ OR ] = 2.09, 95% confi dence interval [ CI ] : 1.082 -4.037, P = 0.028).• On multivariate analysis, level of thrombus (OR = 3.1, 95% CI: 1.30 -7.74, P = 0.011) and association of bland thrombus (OR = 9.07, 95% CI: 2.42 -34.01, P = 0.001) were signifi cant factors for IVC interruption. CONCLUSIONS• Surgical interruption of the IVC is a feasible option in selected patients with chronic IVC obstruction. Association of bland thrombus with tumour thrombus should alert the surgical team to the potential for a challenging surgery.• Precise preoperative imaging to assess the degree of venous obstruction and to help with differentiation between bland and tumour thrombus is key to achieving a surgical outcome with minimal morbidity. KEYWORDSrenal tumour , tumour thrombus , inferior vena cava fi lter , pulmonary emboli , tumour thrombus emboli , bland thrombus emboli Study Type -Therapy (case series) Level of Evidence 4

IVC anomalies are uncommon, usually of little physiological consequence, and mostly discovered incidentally during cross-sectional imaging in otherwise healthy individuals. However, they do have implications of relevance to surgeons because they may lead to significant complications during vascular interventional radiology procedures and retroperitoneal surgery when undiagnosed. This review synthesizes the current literature pertaining the development and identification of IVC anomalies, highlighting their possible implications for surgical procedures involving this retroperitoneal vessel.