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)

Symptomatic Renal Artery Aneurysm Dealt with Aneurysmectomy and Patch Closure

“…Although most aneurysms are detected incidentally, it appears that with the increasing use of diagnostic ultrasound, CT 7, and arteriography, renal artery aneurysms are being identified more often than the past. The rupture risk of RAA is considerably low, no more than 5%, although, more likely in aneurysms that are lager than 2 cm and in non-calcified one (8)(9)(10)(11)(12). Rupture of renal artery aneurysm is associated with 10% mortality and the chance of nephrectomy is very high (7).…”

Sonographic evaluation of renal artery aneurysm in childhood

“…We describe herein a 5 year old presenting with renal vascular hypertension with the unusual finding of R A A secondary to fibromuscular dysplasia. The incidence of R A A , depending on the mechanism of investigation, has varied from 0.015% to 1.32% [1]. R A A have been divided into 4 distinct entities: 1) Fusiform, 2) saccular, 3) dissecting, and 4) intrarenal [2].…”

“…Renal artery aneurysm ( R A A ) occurs at a varied rate from 0.015% to 1.32% as determined either by autopsies or arteriogram series [1]. Whereas this has been well described in the adult population [2], its occurrence is quite rare in children [3].…”

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

“…Renal artery aneurysms (RAA) are rare with an estimated incidence between 0.1% and 1% 1–4. Most patients are asymptomatic and diagnosed incidentally during investigation for other pathologies.…”

“…Most patients are asymptomatic and diagnosed incidentally during investigation for other pathologies. Clinical manifestations include pain, haematuria and hypertension 2 3. While the natural history of these aneurysms is uncertain, rupture is the most dreaded complication.…”