Bilateral ex vivo repair and kidney autotransplantation for complex renal artery aneurysms: A case report and literature review

Abstract

Abstract:We report the surgical management of a bilateral renal artery aneurysm diagnosed in a 41-year-old patient with a history of recurrent abdominal pain. The preoperative contrast-enhanced computed tomography showed a complex saccular aneurysm on both renal arteries within the renal hilum. The characteristics of aneurysms precluded endovascular procedures, and a double-step bilateral ex vivo reconstruction with kidney autotransplantation was planned. The intra-and postoperative period was uneventful. Imaging and laboratory examinations show preservation of renal function, and patient is symptom-free at 10-month follow up.

Treatment of a Complex Renal Aneurysm by Simple Nephrectomy

“…The indication for surgery is still debatable in the literature, with some authors advocating surgery only if the aneurysm is symptomatic, complicated, pregnant, or larger than 2 cm in size, whereas others have recommended surgery for any aneurysm before complications arise [3]. The main indications for renal autotransplantation are complex renal aneurysms, extensive ureteral lesions, and conservative surgery for renal cancer in a patient with a single kidney, with good results reported in the literature [5].…”

Case – Ex-vivo aneurysm resection, autotransplantation, and aortorenal bypass in a solitary kidney with fibromuscular dysplasia

“…Such complex aneurysms have been treated with ex-vivo resection with safety and durability as described in case reports, even in solitary kidneys. [4][5][6] Accordingly, we elected to proceed with a multidisciplinary approach to treat the diseased artery and its aneurysms.…”

“…3,4 Controversy over the criteria for selecting endovascular vs. open repair persists, with ex-vivo resection and renal autotransplantation being described for complex distal RAAs in case reports. [4][5][6] Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic disease affecting arterial walls causing stenosis, or aneurysmal degeneration. 6 Renal artery involvement is most common and 5-10% of patients with FMD present with RAAs.…”

Kidney Auto Transplantation: A Long Forgotten Technique?

“…Exspecially for abdominal aortic aneurysms the PTA is the method of choice which reduced the risk to lose the patient's life, whenever the danger of the loss of kidney function had increased. Because of this fact it is useful to inform the transplant unit about the intervention so a auto transplantation can be planed as the rescue therapy for the kidney function, even in single complicated renovascular disorders (isolated occlusive fibrodysplasia, arteriosclerotic lesions of the kidney artery, or inflammatory lesions) with which PTA does not promise success, or could even be dangerous, auto transplantation is a safe alternative [5][6][7][8][9][10].…”