Endovascular interventions in management of renal artery aneurysm

Abstract

Renal artery aneurysm is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females and patients with multiple comorbidities. Traditionally, aneurysms located in the main renal artery had been successfully treated with endoprosthesis but technical limitations existed in more distal locations where patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization[SACE], balloon-assisted coil embolization[BACE], selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-Hystroacril and Onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization have been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.

Eighteen cases of renal aneurysms: Clinical retrospective analysis and experience of endovascular interventional treatment

“…Therefore, stent grafts are not recommended for renal aneurysms with small blood vessels (<6 mm) or curved vessels (32). Selective coil embolization is also commonly used for saccular aneurysms with a neck diameter of <4 mm or an aneurysm-toneck ratio of 2:1 (33). Type II aneurysm: Due to the special anatomy and location of Type II aneurysms, intravascular interventional therapy is challenging.…”

“…Type II aneurysm: Due to the special anatomy and location of Type II aneurysms, intravascular interventional therapy is challenging. Open vascular surgery, such as external reconstruction, autotransplantation, and nephrectomy, is the standard treatment for fusiform aneurysms in the main renal artery or large segment artery, such as external reconstruction, autotransplantation, and nephrectomy (22,33). Some studies reported that multilayer stents have been used successfully to treat complex renal aneurysms (34).…”

“…For patients with renal aneurysms undergoing treatment, it is recommended to complete a CTA, MRA, or DSA imaging examination before discharge (16,33). They will be followed up and evaluated at 1 month, 6 months, and every year (16,36).…”

Renal artery aneurysm induced by neurofibromatosis type 1: A case report and review of the endovascular interventions for this rare vasculopathy

“…Late postoperative complications included stent stenosis, renal artery thrombosis, renal bypass thrombosis, post-embolization syndrome, and chronic abdominal abscess. [19] Ghosh and Dutta [21] analyzed 14 published studies in which 157 RAAs were treated. The most commonly reported complications are renal infarction (15%), postembolization syndrome (leukocytosis, fever, abdominal pain, nausea and vomiting) (5%), coil migration into the native renal artery compromising a significant area of the renal parenchyma (1.2%), and aneurysm sac expansion reperfusion (<1%).…”