Aneurisma de artéria renal em rim transplantado: reparo ex vivo e reimplante do enxerto

Abstract

Aneurisma verdadeiro de artéria renal em rim transplantado é ocorrência rara. As possibilidades de tratamento dependem do tamanho, da localização do aneurisma e da clínica apresentada pelo paciente. Descreve-se um caso de aneurisma gigante de artéria renal em rim transplantado que recebeu tratamento ex vivo e reimplante na fossa ilíaca direita. Detalhes do procedimento cirúrgico são descritos.

Endovascular Repair of Renal Artery Aneurysm in a Transplanted Kidney 30

“…Despite renal artery aneurysms being mostly asymptomatic, some patients still may present with fever, prolonged anemia, ischemia of the ipsilateral limb, hypertension, compression of adjacent organs, deterioration in graft function, and life-threatening bleeding due to rupture. 1-3,7 Our patient’s aneurysm was diagnosed while investigating the gradual deterioration in his kidney function test.…”

“…Studies advocate the following indications for intervention: symptomatic aneurysms, a size larger than 2.5 cm, if complicated by infection, progressive enlargement with impending risk of rupture. 1,3,4,6,7 Asymptomatic small aneurysms can be managed conservatively with close surveillance. In our report, the indication for treatment was the huge size of the aneurysm with the associated high risk of rupture.…”

“…1-5 Indications for repair include symptomatic aneurysms, size larger than 2.5 cm, the presence of infection, and the progressive increase in size that precipitates a life-threatening rupture. 1,3,4,6,7 Therapeutic options include open surgical repair, ultrasound guided percutaneous administration of thrombin, and endovascular repair. 1,4,6…”

In vivo successful repair of transplant renal artery aneurysm (TRAA) made possible in an Asian transplant unit.

“…A true aneurysm contains all three layers of the blood vessel wall, unlike a pseudoaneurysm [8]. Most of TRAA are asymptomatic but some present with fever, symptoms arising from compression of nearby structures, hypertension, reduced allograft function and rarely life-threatening hemorrhage [9]. There is a potential risk of catastrophic complications if TRAA is left untreated, including aneurysm rupture, renal artery thrombosis and embolus causing renal infarction and dissections.…”

Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso

“…Los aneurismas de la arteria renal pueden tratarse por medio de intervenciones intravasculares o por autotrasplante. La decisión de intervenir quirúrgicamente se toma a partir de condiciones clínicas, como: a) aneurismas de la arteria renal con ubicación compleja, como en la bifurcación de la arteria renal, b) longitud del aneurisma mayor de más de 2 cm, c) mujeres en edad fértil, d) hematuria, e) tromboembolia renal, f ) hipertensión arterial nefrogénica, g) lesiones extensas de los uréteres, y h) tumores renales en pacientes con riñón único [17][18][19] .…”