Angiographic embolization of a ruptured renal artery aneurysm during pregnancy

Abstract

Aggressive management of ruptured and high-risk unruptured aneurysms during pregnancy is indicated. Embolotherapy is an alternate approach if surgery is not possible.

Emergent coil embolization for ruptured renal artery aneurysm

“…Hence, they should be considered as a treatment of choice for a ruptured RAA. 18 1 Embolization with stainless coil Main renal artery Take 19 1 Embolization with stainless coil Proximal main renal artery Sueyoshi 16 1 Embolization with stainless coil Main renal artery Prabulos 11 1 Embolization with stainless coil and gelatin sponge Aneurysm cavity Morimatsu 17 1 Embolization with platinum microcoil Lower arterial branch Schneidereit 15 1 Stent-graft placement Main renal artery Fiesseler 14 1 Embolization with coil Proximal main renal artery Present case 1 Embolization with platinum microcoil Lower arterial branch…”

“…17 In a case in which the aneurysm was 4 cm in diameter, as many as 48 coils with a gelatin sponge were necessary. 11 In the present case, we used microcoils to occlude the orifi ce and the parent artery of the aneurysm, preserving arterial fl ow in about half of the renal parenchyma. As shown in Fig.…”

“…7,9 In case of rupture, the patient complains of severe fl ank pain and abdominal or back pain, macroscopic hematuria, cardiovascular instability, and/or shock. 4,7,11 Death can result from rupture. 7 Mortality in the event of RAA rupture is considered to be approximately 10% at present, 2,3 but the prognosis of peripartum females is poor, with mortality rates of 38% for the mother and 74% for the fetus reported.…”

“…[1][2][3]11,12,[14][15][16][17][18][19] Transcatheter arterial embolization using stainless steel coils or platinum microcoils has been the most frequently employed endovascular treatment for ruptured RAA, as summarized in Table 1. 11,[14][15][16][17][18][19] In the cases reported by Naitoh et al 18 and Take et al 19 , embolization was fi rst performed followed by nephrectomy after the patient's general condition had improved. In all other cases, embolization or stent-graft placement alone was the primary treatment.…”

“…All of the endovascular treatments were successful, and all but one of the patients survived; the one death was due to secondary rupture of a splenic artery aneurysm. 11 Embolization was performed at the main renal artery in four of the six cases in the literature. 14,16,18,19 Only one case was reported in which embolization of an arterial branch with microcoils was successful.…”