Endovascular vs Open Repair of Renal Artery Aneurysms: Outcomes of Repair and Long-Term Renal Function

Tsilimparis, Nikolaos; Reeves, James G.; Dayama, Anand; Perez, Sebastian D.; Debus, Eike Sebastian; Ricotta, Joseph J.

doi:10.1016/j.jamcollsurg.2013.03.021

Cited by 81 publications

(70 citation statements)

References 16 publications

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“…Single unilateral aneurysms appear to favor the right side, with the average reported RAA size being 1.3 to 3.8 cm, and operative series reporting larger diameters. 2,[7][8][9][10]12,[15][16][17][18] Computed tomography is the most common contemporary diagnostic modality, followed by magnetic resonance imaging, ultrasonography, and catheter-based arteriography. 10 A RAA may appear as a signet-ring calcification on roentgenogram.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

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Renal artery aneurysms

Coleman

Stanley

2015

Journal of Vascular Surgery

131

139

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Renal artery aneurysms are rare in the general population, although the true incidence and natural history remain elusive. Controversy over criteria for repair persists across decades. Indications for repair presently include aneurysm size >2 cm, female gender within childbearing age, symptoms like pain and hematuria, medically refractory hypertension including that associated with functionally important renal artery stenosis, thromboembolism, dissection, and rupture. Conventional surgical reconstruction options are variable and continue to offer technically sound and durable results. Endovascular therapies with novel devices also offer technical success with few major adverse events, and are increasingly employed as indications for intervention broaden. This review summarizes the accumulated evidence on true renal artery aneurysms with a particular focus on contemporary treatment criteria, natural history, options for repair and outcomes following such.

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Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…Contemporary rupture rates are estimated at 3% to 5% with nongestational mortality <10%. 2,5,[12][13][14][15] …”

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confidence: 99%

Renal artery aneurysms

Coleman

Stanley

2015

Journal of Vascular Surgery

131

139

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“…In recent years, the advent of endovascular repair also now represents a safe and alternative approach in selected patients. Literature review (Table 1) demonstrates good treatment outcomes of endovascular repair of RAA, with technical success rates of >90% and complication rates of <10%, which is comparable to that of open repair [1][2][3][4][5][6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 90%

Angio-embolization of a Large Renal Artery Aneurysm: A Case Report and Literature Review

Yeo¹,

Neo²,

Lo³

et al. 2017

Angiol

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We report a rare case of a large 7.8 cm renal artery aneurysm with subsequent successful endovascular coil embolization. A 54-year-old lady presented with a 3-day history of gross hematuria. Computed tomography (CT) angiogram revealed a large 7.8 cm right renal artery aneurysm, which was successfully embolized with endovascular coils. 1-month and 12-months surveillance showed preservation of renal function with decreasing aneurysm size. Endovascular coil embolization of large renal artery aneurysm is a safe and viable treatment modality. Literature review demonstrates good treatment outcomes, with technical success rates of >90% and complication rates of <10%.

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“…So far, there are two general endovascular approaches: transcatheter embolization for saccular aneurysms and endovascular stent-grafting for aneurysms that present a sufficient distal and proximal landing zone. Recently, the emergence of new materials and the refinement of endovascular techniques has allowed the introduction of stent-assisted coil embolization or the use of multilayer flow modulator stent, extending the endovascular treatment to multiple types of complex aneurysms (7,8). The most severe complication is the occlusion of the main renal artery due to coil migration.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted detachable coil embolization of wide-necked renal artery aneurysms

Bracale¹,

Narese²,

Ficarelli³

et al. 2017

Diagn Interv Radiol

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R enal artery aneurysms (RAAs) are relatively rare with an estimated incidence of 0.1% in the general population, rupture incidence of about 30%, and a consequent death rate of 80% (1). The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy (29%), mortality (1.6%), and morbidity (12%). Nowadays, an endovascular approach such as coil embolization or stent-graft with coil embolization is an alternative in the treatment of narrow neck RAAs; however, when facing complex wide-necked aneurysms or complex aneurysm bifurcation, a surgical aneurysmectomy may be required. Recently, stent-assisted coil embolization with preservation of renal blood flow, has become a realistic alternative to surgery in wide-necked, saccular or extraparenchymal aneurysms.The aim of this study is to report our experience in the treatment of wide-necked complex RAAs through the stent-assisted detachable coil embolization technique in three patients. One case required a stent-assisted coil embolization with waffle-cone technique due to a wide-necked bifurcation RAA. TechniqueLaboratory investigations including complete blood count, renal and liver function tests, electrocardiography, chest radiography, and ultrasonographic evaluation of the carotid artery, abdominal aorta, and visceral arteries were carried out prior to the procedures. All aneurysms were treated under local anesthesia using a transfemoral approach. After positioning the femoral sheath, an intravenous bolus of 5000 IU of heparin was dispensed. Stent-assisted coil embolization was performed using the Solitaire AB stent nitinol self-expandable electrolytic detachment (Covidien-EV3) and Concerto Axium coils controlled release system (Covidien-EV3). Because of its featured trait of a closed-cell stent with high radial force, Solitaire AB stent does not permit the coils' prolapse and migration, preserving a good blood flow. On the other hand, detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different size aneurysms. After the procedure, the patients were monitored for 48 hours and were discharged with the administration of double antiplatelet therapy, which included acetylsalicylic acid (100 mg daily) and clopidogrel (75 mg daily) for six months. After six months, clopidogrel treatment was interrupted and only acetylsalicylic acid (100 mg daily) was maintained. Case 1A 64-year-old man was admitted to the outpatient clinic for evaluation of a left saccular RAA, diagnosed on CT-scan during routine follow-up of left hemicolectomy for colorectal I N T E R V E N T I O N A L R A D I O LO G Y T E C H N I C A L N OT E ABSTRACTRenal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for...

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Endovascular vs Open Repair of Renal Artery Aneurysms: Outcomes of Repair and Long-Term Renal Function

Cited by 81 publications

References 16 publications

Renal artery aneurysms

Renal artery aneurysms

Angio-embolization of a Large Renal Artery Aneurysm: A Case Report and Literature Review

Stent-assisted detachable coil embolization of wide-necked renal artery aneurysms

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