Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes

Abstract

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.

Technical considerations of endovascular management of true visceral artery aneurysms

“…These two techniques (Fig. 2 ) are helpful to protect the visceral arterial lumen when a covered stent cannot be used (Centenera et al 1998 ; Favelier et al 2012 ), with excellent technical success reaching 100%, and a low rate of major complications (Secco et al 2021 ).

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Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

“…This technique is employed to prevent coil protrusion and migration from the aneurysm neck, as may occur in renal artery aneurysms [ 50 , 51 , 52 ]. A long-armed introducer or a guiding-catheter (6-French) is placed at the origin of the renal artery and, after the advancement of the guidewire beyond the aneurysm, the stent is usually implanted before coil placement.…”

Crush technique for percutaneous management of bifurcation of renal artery aneurysms

“…In rare cases more complex reconstructions, like extracorporeal reconstruction with autotransplantation, or even nephrectomy are needed. All these procedures are primarily aimed at the prophylaxis of aneurysm rupture, but also facilitate pharmacological management of arterial hypertension, which very often accompanies renal artery disease [1][2][3][4][5][6][7][8][9].…”

“…However, since most renal artery aneurysms are located at bifurcations of these blood vessels, their endovascular repair remains challenging. Typical endovascular techniques, such as the standard single-stent or double-stents techniques, can result in incomplete coverage of the aneurysm, floating stent struts, or formation of a long metallic neocarina [ 1 – 4 , 7 , 10 ]. Therefore, techniques that have been developed for the management of lesions located at the bifurcations of coronary arteries – where this problem is also relevant – can be used in these difficult-to-manage arteries [ 11 ].…”