Ex vivo repair and renal auto-transplantation for treatment of a renal artery aneurysm after endovascular failure

Abstract

Renal artery aneurysms are rare and typically found incidentally. Risk of rupture drives the incentive for repair, which can be achieved by both open and endovascular techniques. Ex vivo repair with renal auto-transplantation is recommended for complex aneurysms involving distal or multiple arteries. Here we describe a successful treatment of a renal artery aneurysm after previous endovascular treatment failure. A multi-layered stent was left misplaced inside of the aneurysm. Ex vivo repair with renal auto-transplantation allowed for complete aneurysm exclusion. With increasing use of endovascular techniques, failure of endovascular treatment might become a common indication for ex vivo repair in renal artery aneurysms.

Nephrectomy with Autotransplantation—A Key Treasure

“…In situ repair requires renal artery clamping and is a viable choice when the predicted renal warm ischemia time is less than 30–60 min. In complex aneurysms that include distal or multiple renal arteries, ex vivo repair with autotransplantation may be a safer approach, allowing for adequate exposure and cold perfusion of the kidney during the repair process, ultimately minimizing the warm ischemia time and protecting renal function [ 14 ]. This approach has demonstrated both safety and effectiveness, with post-operative mortality rates varying between 0 and 9.6% [ 23 , 24 , 25 ].…”

“…However, some conditions are not suitable for interventional or endovascular therapies or in situ surgical reconstruction because of anatomical characteristics [ 13 ]. Ex vivo repair is recommended for complex aneurysms involving multiple branches and distal aneurysms, particularly when the anticipated renal ischemic time is likely to exceed 30–60 min [ 14 ]. Van Rooden et al described ex vivo reconstruction and autotransplantation in patients with spontaneous renal artery dissection, primarily associated with fibromuscular dysplasia and presenting as arterial hypertension and renal dysfunction [ 15 ].…”