Experience With Revascularizing Renal Artery Aneurysms: is it Feasible, Safe and Worth Attempting?

Seki, Toshimori; Koyanagi, Tomohiko; Terabe, Masaki; Chikaraishi, Tatsuya; Tanda, Katsutoshi; Kanagawa, Kazuhiro D.

doi:10.1016/s0022-5347(01)64479-3

Cited by 30 publications

(36 citation statements)

References 15 publications

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“…These include nephrectomy, vascular bypass, coil embolization, and stent-graft placement. 4,5 Symptom management and treatment should be determined according to the patient's age, anatomy, and surgical history. In the present case, the shape and location of the aneurysm prevented repair of the renal artery by interventional treatment.…”

Section: Discussionmentioning

confidence: 99%

“…6 However, Seki and associates reported no correlation between total ischemic time and postoperative renal function. 4 Thus, although ex vivo repair in combination with nephrectomy and renal transplant is timeconsuming, it can prevent ischemic damage to the kidney and preserve renal function by reducing warm ischemic time.…”

Section: Discussionmentioning

confidence: 99%

“…Seki and associates also reported that split renal function is stable or improved after ex vivo revascularization and autotransplant for renal artery aneurysms. 4 In addition, these procedures in combination can provide an effective opportunity to safely repair the artery. 7 This is why we selected nephrectomy, ex vivo repair of the renal artery, and renal autotransplant.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Ogawa¹,

Yanagida²,

Kataoka³

et al. 2012

Exp Clin Transplant

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We describe in this report the case of a renal aneurysm in a 42-year-old woman. The aneurysm measured 27 mm in diameter, and was sited at the first bifurcation of the renal artery. We performed laparoscopic nephrectomy, ex vivo angioplasty and renal autotransplant to avoid ischemic damage to the kidney during reconstruction. The patient recovered and was discharged from the hospital without any complications. Hence, we suggest these treatments can be effectively done in patients with complex renal aneurysms. Key words: Renal artery aneurysm, Laparoscopic nephrectomy, Extracorporeal reconstruction, Renal autotransplantation, Renal functionSince renal autotransplant was first described by Hardy in 1963, 1 it has been used to treat patients with renovascular diseases, ureter injuries, and renal tumors. We present the case report of a patient with a renal artery aneurysm who underwent nephrectomy, ex vivo angioplasty of the renal artery, and renal autotransplant who recovered without complications. Case ReportA 42-year-old woman visited the district general hospital, complaining of a history of continuous fever and fatigue. Her urine was clear; however, results of screening abdominal ultrasonography revealed a hypoechoic mass in the upper part of the right kidney. Doctors there suspected a right renal artery aneurysm and referred her to our hospital. On admission, her blood pressure was normal, and serum creatinine and blood urea nitrogen concentrations were within normal ranges. Results of 3-dimensional computed tomography (CT) and selective renal angiography showed a saccular right renal artery aneurysm measuring 27 mm in diameter (Figures 1 and 2). From these images, we also ascertained that the aneurysm originated from the first bifurcation of the renal artery. Results of a subsequent renogram showed normal split renal function of the bilateral kidney. The CT and angiography results indicated that endovascular coil embolization was impossible, owing to the morphology and site of the aneurysm. Based on these findings, the patient was scheduled for laparoscopic nephrectomy, ex vivo repair, and autotransplant.The patient was placed in the lateral decubitus position with the left side down. Three 12-mm ports and a 5-mm port were inserted into the retroperitoneal space. After dissection of the renal hilum, the right renal artery and the aneurysm were

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Ogawa¹,

Yanagida²,

Kataoka³

et al. 2012

Exp Clin Transplant

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“…All (17 kidneys) were elected to undergo SR. Our indication for surgery has already been reported [10], but basically this includes the treatment of hypertension and prevention of potential rupture and gradual loss of renal function from microemboli [11,12]. Because of the complexities of the aneurysm (i.e.…”

Section: Surgical Revascularization In Groupmentioning

confidence: 99%

“…sheer size, number and location with involvement of bifurcation and branches), which precluded its endovascular treatments [7,8], the majority (14 kidneys) were subjected to ex vivo repair, while the rest (3 kidneys) were subjected to in situ repair. The details of each repair have already been reported elsewhere [10]. Every attempt was made to submit the diseased segment (both groups 1 and 2) to histopathological examination.…”

Section: Surgical Revascularization In Groupmentioning

confidence: 99%

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

et al. 2002

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Objective: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). Patients and Methods: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9–69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced ^99mTc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. Results: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. Conclusions: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.

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Covered stent for renal artery aneurysm

Tan

Chough

Saito

et al. 2001

Cathet. Cardiovasc. Intervent.

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Experience With Revascularizing Renal Artery Aneurysms: is it Feasible, Safe and Worth Attempting?

Abstract: The majority of renal artery aneurysm cases are amenable to surgical repair. Carefully performed renal revascularization is rewarding in that high blood pressure is better controlled, renal function is improved and the potential risk of rupture is obviated.

Cited by 30 publications

References 15 publications

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

Covered stent for renal artery aneurysm

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