Stent-Assisted Coil Embolization of an Intraparenchymal Renal Artery Aneurysm in a Patient With Neurofibromatosis

Abstract

True renal artery aneurysms are rare. They are generally asymptomatic, however, a few may present with hypertension, rupture, or renal dysfunction secondary to distal embolization. Indications for intervention include aneurysm of ≥ 2.0 cm in diameter, renovascular hypertension, enlarging aneurysm, associated dissection /rupture, and aneurysms in women of child-bearing age/ pregnancy. Endovascular therapy through coil embolization or stent graft exclusion is the recommended management. Coil embolization of the first and second order branch aneurysms is often associated with distal parenchymal loss and current stent graft technology prohibits use of these endoprostheses in the branch renal arteries. In this report, we describe successful stent-assisted coil embolization of an intraparenchymal aneurysm while preserving the distal parenchyma in a young woman with Neurofibromatosis type 1.

Clinical Outcomes of Conservative Treatment in Patients with Symptomatic Isolated Spontaneous Renal Artery Dissection and Comparison with Superior Mesenteric Artery Dissection

“…1 In the setting of renal artery aneurysm and/or rupture or leak from the aneurysm, particularly in the presence of renovascular hypertension and in women of childbearing age, renal artery embolisation has been successfully used. 26,27 Although there is no consensus yet, some proposed criteria for surgical repair include the presence of a correctable dissection that causes haemodynamically significant acute occlusion accompanying the dissection of main or major segmental renal arteries, uncontrolled renovascular hypertension resistant to medical treatment, and significantly deteriorating renal function. 2,5,28e32 Surgical repair, including renal artery revascularisation and nephrectomy, was reported as the definitive treatment in a few previous studies 4,28e31 ; renal artery revascularisation is technically demanding because of frequent branch renal artery involvement and perivascular scarring, and renal salvage is not always possible, 2,5 whereas primary nephrectomy could be considered to treat uncontrolled malignant hypertension in selected patients with already severely damaged kidneys or renal artery branch involvement.…”

Evaluation of characteristics, associations and clinical course of isolated spontaneous renal artery dissection

“…In the setting of aneurysm formation of the renal artery and/or rupture or leak from the aneurysm particularly in the presence of renovascular hypertension and in women of childbearing age, renal artery embolization has been successfully employed [49,50].…”

Spontaneous Accessory Renal Artery Aneurysm Rupture in a Patient With Neurofibromatosis Type 1: A Case Report

“…Renal aneurysms are most commonly located in the main renal artery or the first-order branches. 7 Angiographic prevalence is only 0.3% to 0.7%, and they rarely rupture, reportedly 0% to 10%. 1 The main risk factors for renal artery aneurysm include hypertension, fibromuscular dysplasia, and atherosclerosis.…”

“…3 These aneurysms are usually asymptomatic, but the complications that can arise include renovascular hypertension, spontaneous rupture, distal embolization, renal infarction, and arteriovenous fistula. 7 Risk factors for rupture of renal artery aneurysms are size >2.0 cm, progressive growth in size, incomplete calcification, hypertension, and pregnancy. 2 In our case, the patient did not have a history of hypertension, was not pregnant, no calcification was noted on the CT or angiogram, and without prior imaging, it is difficult to discern the prior size of the aneurysm.…”