The contemporary management of renal artery aneurysms

Abstract

This large, contemporary, multi-institutional study demonstrated that asymptomatic RAAs rarely rupture (even when >2 cm), growth rate is 0.086 ± 0.08 cm/y, and calcification does not protect against enlargement. RAA open repair is associated with significant minor morbidity, but rarely a major morbidity or mortality. Aneurysm repair cured or improved hypertension in >50% of patients whose RAA was identified during the workup for difficult-to-control hypertension.

Renal artery aneurysms

“…[9][10][11] The most recent and largest multiinstitutional series of nonoperative RAA surveillance found no difference in growth rate based on aneurysm morphology or calcification. 10 These same authors also report the successful surveillance of 88 aneurysms measuring 2 to 3 cm and seven aneurysms measuring >3 cm without complication or rupture during a mean of 49 months. Contemporary rupture rates are estimated at 3% to 5% with nongestational mortality <10%.…”

“…2 Most ruptures are diagnosed at the time of presentation, and several authors have supported no rupture during the surveillance of nonoperative RAAs. 1,2,4,5,[7][8][9][10][11] Contemporary series estimate a median annualized growth rate of 0.06 to 0.6 mm. [9][10][11] The most recent and largest multiinstitutional series of nonoperative RAA surveillance found no difference in growth rate based on aneurysm morphology or calcification.…”

“…1,2,4,5,[7][8][9][10][11] Contemporary series estimate a median annualized growth rate of 0.06 to 0.6 mm. [9][10][11] The most recent and largest multiinstitutional series of nonoperative RAA surveillance found no difference in growth rate based on aneurysm morphology or calcification. 10 These same authors also report the successful surveillance of 88 aneurysms measuring 2 to 3 cm and seven aneurysms measuring >3 cm without complication or rupture during a mean of 49 months.…”

“…Single unilateral aneurysms appear to favor the right side, with the average reported RAA size being 1.3 to 3.8 cm, and operative series reporting larger diameters. 2,[7][8][9][10]12,[15][16][17][18] Computed tomography is the most common contemporary diagnostic modality, followed by magnetic resonance imaging, ultrasonography, and catheter-based arteriography. 10 A RAA may appear as a signet-ring calcification on roentgenogram.…”

“…2,[7][8][9][10]12,[15][16][17][18] Computed tomography is the most common contemporary diagnostic modality, followed by magnetic resonance imaging, ultrasonography, and catheter-based arteriography. 10 A RAA may appear as a signet-ring calcification on roentgenogram. Conventional preoperative arteriography is warranted, given the frequency of multiple aneurysms affecting distal branches that may be missed on conventional cross-sectional imaging.…”