Surgical management of renal artery aneurysms

English, William P.; Pearce, Jeffrey D.; Craven, Timothy E.; Wilson, David B.; Edwards, Matthew S.; Ayerdi, Juan; Geary, Randolph L.; Dean, Richard H.; Hansen, Kimberley J.

doi:10.1016/j.jvs.2004.03.024

Cited by 148 publications

(111 citation statements)

References 33 publications

(36 reference statements)

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“…6 When an aneurysm is identified, surgery is the best treatment option, in order to avoid hypertension or rupture of the aneurysm, especially in cases in which the aneurysm is larger than 2 cm in diameter and considered to comprise complex RAA. 2 RAT is mainly indicated in three situations: extracorporeal reconstruction of complex aneurysms of the renal pedicle; extensive ureteral injury; and conservative surgery due to kidney cancer in patients with only one kidney. Furthermore, RAT should be considered for treating renal artery aneurysm that is found to be untreatable by means of endovascular methods.…”

Section: Discussionmentioning

confidence: 99%

Renal autotransplantation to treat renal artery aneurysm: case report

et al. 2014

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CONTEXT: Renal artery aneurysm (RAA) is uncommon and usually asymptomatic, but complications like rupture or thromboembolism of the aneurysm can occur, with consequent renal infarction. Most of the clinical findings are found incidentally through imaging examinations, in investigating other diseases. Renal autotransplantation (RAT) is an alternative treatment for complex RAA, with satisfactory results described in the literature. CASE REPORT: The patient was a 48-year-old man with a history of systemic arterial hypertension, thrombocytopenia and advanced hepatosplenic schistosomiasis. He complained of right lumbar pain, which was investigated through imaging examinations (computed tomography and angiotomography). These revealed right RAA of 2.5 cm in diameter. Evaluation by the vascular surgery team found that this was untreatable using endovascular methods. The treatment performed was open right nephrectomy with kidney preservation in solution, followed by aneurysmectomy, suturing of the injured artery and kidney reimplantation in the right iliac fossa with anastomosis of the iliac vessels and ureter. The durations of the surgery and kidney ischemia were 385 and 140 minutes, respectively. The patient was discharged on the 20 th postoperative day, with creatinine concentration of 1.4 mg/dL, urea 41 mg/dL, urine volume 1400 mL/24 h and ascites treated with diuretics. CONCLUSION: RAT is indicated basically in three situations: extracorporeal reconstruction of complex aneurysms of the renal pedicle, extensive ureteral injury, and conservative kidney cancer surgery in patients with a single kidney. This study presents a case of a patient with advanced liver disease and RAA that was untreatable using endovascular methods and was successfully treated using RAT. RESUMOCONTEXTO: O aneurisma de artéria renal (AAR) é incomum e, em geral, assintomático, mas podem ocorrer complicações como rotura ou embolia de trombos do aneurisma com consequente infarto renal. A maioria dos achados clínicos é encontrada acidentalmente por exames de imagem na investigação de outras doenças. O autotransplante renal (ATR) constitui-se em alternativa de tratamento de AAR com resultados satisfatórios descritos na literatura. RELATO DE CASO: Paciente masculino, 48 anos, com histórico de hipertensão arterial sistêmica, plaquetopenia e esquistossomose hepatoesplênica avançada. Referia dor lombar direita que após exames de imagem (tomografia computadorizada e angiotomografia) revelou AAR direita com 2,5 cm de diâmetro não tratável por via endovascular após avaliação da equipe de cirurgia vascular. O tratamento realizado foi uma nefrectomia aberta direita com preservação renal em solução, seguida de aneurismectomia, sutura da artéria lesada e reimplante do rim na fossa ilíaca direita com anastomoses dos vasos ilíacos e do ureter. O tempo cirúrgico e de isquemia renal foram de 385 e 140 minutos, respectivamente. Recebeu alta hospitalar no vigésimo dia do pós-operatório, com concentrações de creatinina de 1,4 mg/dL, ureia de 41 mg/dL, volume u...

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Section: Discussionmentioning

confidence: 99%

Renal autotransplantation to treat renal artery aneurysm: case report

et al. 2014

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“…FMD was the most prominent cause of aneurysm in 34-54% of the patients who underwent reconstruction for renal artery aneurysm (RAA). 4,7,8) FMD causes arterial stenosis due to hyperplasia of the media or intima, and the underlying arterial matrix disruption that exists in these dysplastic arteries may lead to aneurysm formation. A majority of true RAAs are asymptomatic and are discovered during detailed investigation for hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Renal artery aneurysms have been frequently reported to be associated with FMD. [3][4][5] In this report, we present a rare case of multivisceral FMD involving the superior mesenteric artery (SMA) and the right renal artery with stenosis, and the left renal artery with aneurysm formation.…”

Section: Introductionmentioning

confidence: 99%

Multivisceral Fibromuscular Dysplasia: An Unusual Case of Renal and Superior Mesenteric Involvement

Kimura

Ohtake

Kato

et al. 2010

Annals of Vascular Diseases

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Fibromuscular dysplasia (FMD), a disease process which leads to arterial stenosis and aneurysm formation, has been reported to occur in almost every arterial bed in the body. However, multivisceral FMD is rare, and we report a 43-year-old woman with hypertension who had incidental finding of FMD of both renal arteries and the superior mesenteric artery (SMA). The left renal aneurysms and right renal stenosis were successfully treated by aneurysm resection and aortorenal bypass and percutaneous transluminal angioplasty, respectively. The asymptomatic FMD of the SMA was treated conservatively. The indications for intervention in patients with asymptomatic FMD have not been clarified till date, and we therefore advise a close surveillance program.

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“…O tamanho do aneurisma como parâmetro exclusivo para a indicação do tratamento não deve ser a regra, devendo ser considerado dentro de um contexto que leve em conta a idade do paciente, a presença de sintomas e a hipertensão severa associada, como no caso apresentado. Não é recomendado o reparo de aneurismas da artéria renal menores do que 20 mm de diâmetro em adultos que não apresentem sintomas e/ou hipertensão arterial renovascular severa associados 12 .…”

Section: Discussionunclassified

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

et al. 2007

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ResumoO tratamento endovascular da doença aneurismática da artéria renal tem sido, cada vez mais, aceito como uma alternativa à cirurgia convencional, especialmente em casos de aneurismas complexos intra-parenquimatosos ou que comprometam a bifurcação da artéria renal. Os autores relatam a experiência do tratamento endovascular de uma paciente com aneurisma sacular da bifurcação da artéria renal direita, associado à hipertensão renovascular de difícil controle. Foi realizada a cateterização seletiva da artéria renal, com a inserção de micromolas no saco aneurismático. O aneurisma foi completamente ocluído com preservação total do fluxo sanguíneo renal. A evolução clínica foi satisfatória com redução significativa das medicações anti-hipertensivas. A angio-tomografia de controle, após o oitavo mês do procedimento, confirmou o sucesso do tratamento. Palavras-chave:Embolização terapêutica, artéria renal, aneurisma. AbstractEndovascular treatment of renal artery aneurysmal disease has been increasingly accepted as an alternative to conventional surgery, especially in cases of renal artery bifurcation or complex intrarenal aneurysms. The authors report a case of endovascular treatment of a saccular aneurysm of the right renal artery bifurcation associated with poorly controlled renovascular hypertension. Selective catheterization of the renal artery was performed and microcoils were inserted into the aneurysmal sac. The aneurysm was completely obliterated with total preservation of renal blood flow. Clinical evolution was satisfactory with significant reduction in anti-hypertensive drugs. Control tomographic angiography, after eight months, confirmed treatment success.Keywords: Therapeutic embolization, renal artery, aneurysm. IntroduçãoO tratamento cirúrgico dos aneurismas de artéria renal é, geralmente, complexo. A conduta adotada com maior freqüência é a aneurismectomia combinada com a arterioplastia ou ponte aorto-renal. A aneurismectomia pode ser realizada com sucesso em mais de 95% dos casos de aneurismas extra-parenquimatosos, enquanto o tratamento de certos tipos de aneurismas intraparenquimatosos ou que comprometem a bifurcação da artéria renal pode levar à nefrectomia parcial ou total. Recentemente, o tratamento percutâneo tem sido empregado com maior freqüência para estes casos de aneurismas complexos, evitando complicações isquêmi-cas renais e nefrectomias 1,2 .Relatamos o caso de uma paciente em que foi realizado o tratamento endovascular por embolização com micromolas de um aneurisma sacular da bifurcação da artéria renal, com preservação completa do fluxo sanguíneo renal.

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Surgical management of renal artery aneurysms

Cited by 148 publications

References 33 publications

Renal autotransplantation to treat renal artery aneurysm: case report

Renal autotransplantation to treat renal artery aneurysm: case report

Multivisceral Fibromuscular Dysplasia: An Unusual Case of Renal and Superior Mesenteric Involvement

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

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