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

Abstract

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

Anesthetic considerations in pediatric renal autotransplantation

“…The first renal autotransplant was described by Hardy in 1963 (Ogawa et al 2012). It involves donor nephrectomy and a standard renal transplant in the same patient.…”

Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso

“…Después de analizar la evidencia disponible y las publicaciones de otros autores, desde el punto de vista de nuestro grupo quirúrgico, consideramos que la mejor opción terapéutica para aneurismas de la arteria renal localizados después de la bifurcación del tronco principal, es la nefrectomía con reparación ex vivo y autotrasplante con anastomosis a vasos iliacos; incluso, en pacientes con riñón único, es una opción segura de tratamiento en manos de un equipo quirúrgico con experiencia 1,[29][30][31][32][33][34][35][36] .…”

“…Desde que fue reportado el primer autotrasplante en 1963, se ha utilizado en casos de anormalidades vasculares, lesiones de los uréteres y tumores renales; sin embargo, la evidencia acerca del procedimiento es poca debido a su poca frecuencia 1 . Por otro lado, y en lo que tiene que ver con las indicaciones de origen vascular, los aneurismas de la arteria renal son extremadamente raros en la práctica clínica, representan el 0,3 % de todos los aneurismas abdominales 2 .…”

Treatment of Complex, Combined Renal Artery Aneurysm and Renal Arteriovenous Fistula with Nephrectomy

“…Nephrectomy with ex vivo angioplasty and autotransplantation has also been reported. 9,10 Treatment of RAA differs depending on the type of aneurysm utilizing Rundback's classification. Type I aneurysms can be treated with stent grafts or coil embolization.…”