Role of heterotopic kidney auto-transplantation for renal artery aneurysms

Abstract

To assess the applicability and surgical outcomes of ex vivo repair with heterotopic kidney auto-transplantation (HKA) for the treatment of renal artery aneurysms (RAA).We retrospectively examined 36 cases presenting with RAA from September 2005 to June 2016. Patient demographics, estimated glomerular filtration rate (eGFR), and common vascular risk factors were evaluated. Patients were classified into 3 groups: those who received endovascular treatment, in situ open surgical repair, or ex vivo repair with HKA. The findings were compared among the groups.The endovascular repair, in situ open repair, and ex vivo repair with HKA groups included 14, 9, and 13 patients, respectively (mean follow-up, 30.42 ± 30.54 months). The eGFR (P = .32) and number of anti-hypertension medications (P = .33) did not significantly differ among the groups. Moreover, 3 renal infarctions were detected in the endovascular group and only 1 was detected in the in situ repair group. One patient in the endovascular repair group required dialysis due to renal failure. Patients in the ex vivo repair with HKA group did not exhibit any complications.With safety and effectiveness comparable to other RAA treatment methods, ex vivo repair with HKA for RAA treatment appears suitable particularly in cases with complicated renal artery branch aneurysm and marginal renal function.

Indications for and results of renal autotransplantation

“…Reassuringly, Dezfouli et al [41 ▪▪ ] report 100% renal artery aneurysm repair rate without mortality across 11 patients who underwent coil embolization, in-situ repair, or RA. However, like prior comparative series [42], hospital length of stay was shorter among endovascular repair vs. RA patients (5.3 vs. 21.3 days, P = 0.01); moreover, two of three patients required re-operation for procedure-related complications in the RA group compared to none in the coil embolization group [41 ▪▪ ].…”

Outcomes of endovascular, open surgical and autotransplantation techniques for renal artery aneurysm repair: a systematic review and meta‐analysis

“…Of these, 11 were comparative studies. 19,[22][23][24][25][26][27][28][29][30][31] The remaining 27 were case series, with 14 EVR, 12,[32][33][34][35][36][37][38][39][40][41][42][43][44] seven OR, 2,45-50 and six ERAT studies. [51][52][53][54][55][56] Patient numbers ranged from four to 2709, with the study by Buck et al 23 being the largest study on RAA management to date.…”

Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review

“…There are 2 option regarding RAA repair: in-situ or ex-vivo repair. 3 In-situ repair is reserved for simple cases, and can be done laparoscopically or robotically. 118 These approaches are not recommended for multiple or complex aneurysms, especially located in artery bifurcations, right mid renal artery or whence distal vascular control might be challenging and long ischemia time are required to perform anastomosis.…”