Anatomic characteristics and natural history of renal artery aneurysms during longitudinal imaging surveillance

Wayne, Erik; Edwards, Matthew S.; Stafford, Jeanette M.; Hansen, Kimberley J.; Corriere, Matthew A.

doi:10.1016/j.jvs.2014.03.006

Cited by 43 publications

(12 citation statements)

References 11 publications

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“…Only three studies to date have documented the natural history of RAAs using growth rates (Table IV). [16][17][18] This dearth of knowledge in the literature regarding the natural history of RAAs is consequential because it has traditionally been recommended that RAAs >2.0 cm undergo repair to avert a potentially fatal rupture event. [5][6][7][22][23][24] However, controversially, some current evidence indicates that a 2.0-cm threshold for intervention may be too aggressive.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,8,11,12 Whereas several series have observed patients with RAAs over time without rupture, 3,[13][14][15] only three studies have evaluated RAA growth rates to date. [16][17][18] The largest of these studies reported a mean growth rate of 0.086 6 0.08 cm/y for 454 RAAs observed during a mean period of 49 months. 16 Given the limited knowledge of the natural history of RAAs in the literature, the objectives of our study were to evaluate outcomes of treated RAAs (open and endovascular) and to delineate the growth and rupture rates of those RAAs managed nonoperatively at Yale-New Haven Hospital.…”

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confidence: 99%

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Natural history and management of renal artery aneurysms in a single tertiary referral center

Brownstein

Erben

Rajaee

et al. 2018

Journal of Vascular Surgery

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RAAs tend to have a benign natural history. Although previous reports have not identified any factors that contribute to RAA growth, we observed that RAA location, sex, smoking history, and hypertension may have an impact on growth rates. No ruptures were observed. Operative repair at our institution was rare, with no morbidity or mortality. Observation of RAAs over time seems feasible in the asymptomatic patient with a small RAA.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Natural history and management of renal artery aneurysms in a single tertiary referral center

Brownstein

Erben

Rajaee

et al. 2018

Journal of Vascular Surgery

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“…RAA is a rare disorder, and multiple RAAs, which occur in about 18% of the RAA cases, are even more rare in the general population [ 4 ]. It is difficult to reach a consensus on the appropriate indications for intervention in RAAs, due to the numerous aspects involved, such as the clinical symptoms (hematuria, refractory hypertension, persistent back pain and renal infarction), the anatomical and morphological characteristics of RAAs (size, location, wall calcification and enlarging lesion), and general clinical features (life expectancy, comorbidities and planned pregnancy) [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic reconstructed management of multiple aneurysms in renal artery primary bifurcations: a case report and literature review

Liu

Wang

et al. 2017

BMC Urol

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BackgroundRenal artery aneurysm (RAA) is rare and its incidence in the general population remains elusive. There have been few reports on the repair of multiple aneurysms conducted with the Da Vinci robot-assisted surgical platform (Intuitive Surgical Inc., Sunnyvale, CA, USA), especially for those located in renal artery primary bifurcations.Case presentationWe report our experience in the surgical management of two expanding right-sided RAAs in a 64-year-old man using a robot-assisted laparoscopic approach. Two aneurysms were located in renal artery primary bifurcations, whose diameter was 1.8 and 1.2 cm. The aneurysms were resected and the renal artery branch reconstructed by in situ arteriorrhaphy. The operation lasted for 2 h and 35 min with a warm ischemia time of 26 min and estimated blood loss of 150 ml. The hospital stay was 6 days. The computed tomography (CT) scan performed 2 months after the surgery showed resolution of the aneurysms. Additionally, split renal function indicated the preservation of right renal function in the follow-up period.ConclusionsThe robot-assisted laparoscopic procedure is a safe and effective surgical technique, which may be considered as an alternative to open surgery for complex multiple RAAs in the future.

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“…This is similar to that found in previous studies. 5 , 6 ) We discovered that the growth rate is faster when the baseline diameter is >20 mm (p=0.036). However, some aneurysms grow slowly even though their diameter is >20 mm: these aneurysms belong to the whole-completed calcification type.…”

Section: Discussionmentioning

confidence: 92%

Natural History and Chronological Growth Rate of Renal Artery Aneurysms

Umetsu

Gotō

Ohara

et al. 2017

Annals of Vascular Diseases

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Objective: Renal artery aneurysm (RAA) is an uncommon disease, the natural course of which is still not well known. The objective of this study is to define factors that affect the growth rate of RAAs.Materials and Methods: We retrospectively reviewed 32 aneurysms in 26 patients at our institute between January 2010 and March 2016. Basal demographics, comorbidities, reason for diagnosis, and details of the aneurysms and interventions were recorded. The chronological changes in the diameter of the RAA using multiplanar reconstructions of computed tomography images were measured and analyzed.Results: The baseline mean diameter was 20.1±8.4 mm (range: 9.9–41). The mean follow-up period was 3.13±2.1 y (range: 0.5–7.1). The median growth rate was 0.35 mm/y (interquartile range: 0.05, 0.62). The growth rate was slower when the initial diameter was <20 mm than when it was >20 mm (p=0.036). Also, whole-completed calcification was a significant factor for slower growth (p=0.016). We performed ex-vivo surgery in two cases and coil packing with stenting in one. No ruptures occurred during the study period.Conclusion: Our results suggest that cases with an RAA diameter <20 mm do not require intervention. The interval period can be longer in whole-completed calcification types.

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Anatomic characteristics and natural history of renal artery aneurysms during longitudinal imaging surveillance

Abstract: Risk of short-term RAA growth or rupture was low. These findings suggest that annual (or less frequent) imaging surveillance is safe in the majority of patients and do not support pre-emptive repair of asymptomatic, small-diameter RAAs.

Cited by 43 publications

References 11 publications

Natural history and management of renal artery aneurysms in a single tertiary referral center

Natural history and management of renal artery aneurysms in a single tertiary referral center

Robot-assisted laparoscopic reconstructed management of multiple aneurysms in renal artery primary bifurcations: a case report and literature review

Natural History and Chronological Growth Rate of Renal Artery Aneurysms

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