Renal artery aneurysm: Selective treatment for hypertension and prevention of rupture

Abstract

Thirty-nine patients with renal artery aneurysm (RAA) were seen over a period of 15 years. Among 20 women and 19 men, 31 were found to have solitary aneurysms, and eight had multiple RAA. Thirty-three patients had diastolic hypertension; nine of them proved to be of renovascular origin. Of the 18 patients who underwent RAA resection, 13 had reconstruction for treatment of hypertension, three had a solitary functional kidney, one had recurrent flank pain, and one had resection for prevention of rupture in a woman of childbearing age. Six of the 18 patients had aneurysmorrhaphy with primary repair or patching, seven had a resection with an aortorenal bypass, and five patients had six ex vivo renal reconstructions with multiple anastomoses. Nephrectomy was performed in two patients with RAA rupture at the time of childbirth and in one patient with hypertension and RAA in a poorly functioning kidney. Reconstructive procedures for documented renovascular hypertension in seven patients resulted in improvement in all cases. Blood pressure improved in only six of 10 patients operated on with hypertension and no lateralization of renovascular studies. Eighteen patients were observed for one to 16 years without surgery, and none experienced rupture. Resection of RAA is indicated to treat patients with renovascular hypertension, patients with hypertension and a solitary functional kidney, and selected patients with severe hypertension and to prevent rupture in women who may become pregnant. Other patients with asymptomatic RAA can be safely observed clinically without serial arteriograms and without fear of rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

Tratamento endovascular de aneurisma da artéria renal por embolização com micromolas preservando o fluxo sangüíneo renal: relato de caso

“…Diversas razões são sugeridas para este efeito, entre elas: embolização, compressão extrínseca e tortuosidade da artéria adjacente 5 . Embora o mecanismo exato para as alterações de fluxo ainda seja assunto de debate, tem-se obtido melhora do controle da pressão arterial após a ressecção de aneurismas da artéria renal em pacientes que demonstram estudos funcionais com lado afetado ipsilateral ao do aneurisma 6 .…”

“…Por outro lado, têm sido relatados casos com ruptura de aneurismas com diâme-tros inferiores 6,7 . O tipo fusiforme e as calcificações da parede arterial sugerem proteção contra a ruptura.…”

Renal artery aneurysms and hypertension

“…3,4 Rupture is the most lethal complication of renal aneurysm and is rare. This complication has been mostly reported during pregnancy.…”

“…2,3 In women with potential for pregnancy, renal artery aneurysms should be excised regardless of aneurysm size. 2,3 Earlier detection and improved surgical techniques using resection with vein patch angioplasty, or saphenous (Figure 2), polytetrafluoroethylene or Dacron graft, have almost eliminated the need for nephrectomy. 2,3 Where there is extensive branch involvement, ex vivo repair may be a useful alternative for renal salvage.…”

“…2,3 Where there is extensive branch involvement, ex vivo repair may be a useful alternative for renal salvage. 2,3 …”