Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms / Reparo Ex Vivo de Aneurismas Intraparenquimatosos Múltiplos da Artéria Renal

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Renal artery aneurysm misdiagnosed as renal cell carcinoma

Renal tumors are best diagnosed by contrast-enhanced computed tomography (CECT) abdomen along with history and physical examination. In case of suspicious lesions in respect to location like lesion arising from the bifurcation of renal artery and close to major vessels with all features suggesting of tumor with absent contrast enhancement and absent color flow on Doppler study should be further investigated keeping other possibility of Renal artery aneurysm with thrombus mimicking as renal tumor. CT angiography should be done in every case of suspicious lesion because this will change the further management protocol from Nephrectomy in case of renal tumor to kidney preserving minimally invasive procedure for renal artery aneurysm. Like in this case diagnosis of Renal cell carcinoma was made on the basis of CECT abdomen findings and managed further as per the management protocol for renal tumor but intraoperatively found renal artery aneurysm. On conclusion every suspicious lesion of kidney should be further investigated for renal artery aneurysm so that kidney preserving procedure could be planned preoperatively.

Ruptured renal artery aneurysm in a pregnant woman: case report and literature review / Ruptura de aneurisma de artéria renal em gestante: relato de caso e revisão da literatura

Abstract Renal artery aneurysms (RAAs) are rare and usually asymptomatic; ~ 90% of them are unilateral. Once diagnosed during pregnancy, they may rupture, presenting a high maternal-fetal risk. The present study reports the case of a 32-year-old pregnant woman with a 30-week gestational age and a ruptured unilateral RAA.

Resumo Os aneurismas de artéria renal (AAR) são raros, normalmente assintomáticos, e ~ 90% dos casos são unilaterais. Uma vez diagnosticados durante a gestação, estes podem se tornar predisponentes a rotura e apresentar elevado risco materno-fetal. O presente artigo relata o caso de uma gestante de 32 anos, com idade gestacional de 30 semanas e quadro de AAR unilateral roto.

Surgical Treatment of Renal Artery Aneurysm / 日本心臓血管外科学会雑誌

Most renal artery aneurysms are asymptomatic and the indication of surgery for renal artery aneurysm is controversial. We encountered 3 cases of renal artery aneurysms that were found incidentally during imaging studies. We used urological approach to undergo renal or adrenal surgery and we injected renal protection solution into the kidney after clamping the renal artery, later we underwent renal artery aneurysmectomy. In all cases, we got good operative field, and they went an uneventful postoperative course without deterioration of renal function. In surgical treatment of renal artery aneurysm, this approach method, reconstructive procedure, and renal protection are satisfied enough.

Hand-Assisted Laparoscopic Nephrectomy and Auto-Transplantation for a Hilar Renal Artery Aneurysm: A Case Report

A 52-year-old man was admitted with an incidentally detected right renal artery aneurysm (RAA). Computed tomographic angiography with three-dimensional reconstruction revealed that the aneurysm was 2.2 cm in diameter and located at the renal hilum. We performed hand-assisted laparoscopic nephrectomy with ex vivo repair of the RAA and auto-transplantation with minimal elongation of Gibson incision. The operation and postoperative course were uneventful. At last follow-up, the patient was alive with a well-functioning auto-transplant. Hand-assisted laparoscopic nephrectomy and auto-transplantation is a useful treatment option for hilar RAA.

Clinical analysis of renal artery branch lesions caused by fibromuscular dysplasia in children / 中华实用儿科临床杂志

Objective To explore the lesion types of renal branches and evaluate the clinical results of endovascular treatment for renal artery branch lesions associated with fibromuscular dysplasia (FMD).Methods Eight cases with renal artery branch lesions due to FMD from June 2014 to December 2015 in Department of Vascular and Endovascnlar Surgery,Henan Provincial People's Hospital were retrospectively reviewed.The computed tomography angiography was routinely performed to ascertain the property of renal artery lesion,and digital-subtraction angiography was further performed to confirm FMD diagnosis and analyze lesion characteristics.The renal artery branch lesion types,blood pressure (BP),renin activity,glomerular filtration rate (GFR) and restenosis after operation were observed,and the outcomes were recorded.Results In 8 patients,6 patients were found with the second grade renal branch lesions and 2 patients were found with tertiary branch lesions,involving 2 and more branch arteries for 4 cases and 1 branch for 4 cases.Five cases with branch-type cystic dilatation or aneurysms with coexisting stenosis including 1 case with dissecting aneurysm and renal local infarction,and 1 case with aneurysm located in the bifurcations of branches,and 3 cases with only branch stenosis were found.The angiography showed the small branch lesions of renal artery indicating FMD-mediated focal (5 cases) and multiple stenosis (3 cases).The branch stenosis was not operated in 1 case with dissecting aneurysm and renal local infarction,as BP could be controlled by antihypertensive treatment.Other 7 cases underwent endovascular angioplasties and the technical successful rate was 100％ without complications.After 1 week of operation,BP was improved,renal function remained normal,plasma renin activity was reduced and GFR was recovered for all patients.During the follow-up period (3 to 12 months),BP improvement was observed in 3 cases,and cure were found in 4 cases,and patient's GFR and plasma renin activity were improved in all patients.There were 2 cases with re-intervention during the follow-up period due to restenosis,and the involved branches were unobstructed without obvious stenosis after 1-year follow-up.Conclusions FMD can affect the renal branch artery with different lesions types and endovascular treatment is the first choice for the renal branch lesion of FMD.

Cirugía de banco y autotrasplante en aneurisma complejo de arteria renal / Complex renal artery aneurysm: ex vivo repair and reimplantation

Introduction: True incidence of renal artery aneurysms is unknown but it has been estimated to be around 1 percent. They are usually asymptomatic and diagnosed through imaging studies done for other medical reasons. Those that are more than 2 cm in diameter or any aneurysm in pregnant women should be treated because of an elevated risk of rupture. We present a case of a man with a complex 2.5 cm renal artery aneurysm, successfully treated with ex vivo repair and reimplantation by a multidisciplinary team.

Introducción: La incidencia real de los aneurismas de arteria renal es desconocida, pero se ha estimado en aproximadamente un 1 por ciento. Normalmente los pacientes son asintomáticos y su diagnóstico es habitualmente un hallazgo de estudios de imágenes solicitados por otras causas. El riesgo principal de los aneurismas mayores de 2 cm de diámetro o aquellos en mujeres embarazadas es la rotura. Caso clínico: Presentamos el caso de un hombre con diagnóstico de aneurisma complejo de arteria renal izquierda, que fue sometido a reparación exitosa.

Clinic evaluation of interventional treatment for renal artery aneurysm / 中华泌尿外科杂志

Objective To evaluate the safety and efficacy of interventional procedure for treating the renal artery aneurysm (RAA).Methods From Jan 2009 to Apr 2014,17 patients,who were diagnosed as RAA and accepted the interventional therapy,were reviewed in our hospital.The mean age in those patients,including 7 males and 10 females,was (46.4±10.3) years old (range from 20 to 67 years old).The related symptoms included backache in 4 cases,abdominal pain in 4 cases,intermittent hematuria in 2 cases,chyluria in one case,oligouria in one case.9 cases were diagnosed as multiple RAA and 8 cases were confirmed as signle cases.In 17 cases,31 aneurysms were found,including 26 true aneurysms,5 pseudoaneurysums,17 sacculated aneurysms,4 spindle-like aneurysms,4 irregular shape aneurysms,4 parenchyma aneurysm and 2 dissecting aneurysm.8 aneurysms located in the main renal artery,19 aneurysms located in the branch of renal artery,4 aneurysums located in the renal parenchyma.Intracavitary coil embolization was used in 4 patients.We carried out parent artery embolization in 3 patients.A combination of the former techniques was performed in 6 cases.Covered stent placement was operated in one case.Combination of the intracavitary coil embolization and nude stent placement were performed in 2 patients.We used two techniques in one patient with multiple artery aneurysms in both sides.Results The interventional treatment of RAAs succeed at the first operation in 16 of 17 patients.17 cases were followed-up from 3 to 53 months (mean 23 months).No severe complications or death cases occurred in this study.Urine occult blood in 3 patients turned to negative after one week.Primary symptoms such as gross hematuria,abdominal pain,lumbodorsalgia,fever vanished or obviously eased after a month.Laboratory tests showed that normal level in SCr,BUN,routine urinalysis 3 months,6 months and 1 year later.No tendency of stent and coil stent shifting was found in 16 patients and the parent arteries were patent in 8 cases,with reexamination bv ultrasonic or computed tomography angiography (CTA).Conclusions Interventional techniques are minimally-invasive,safe and effective methods for treating the RAAs.

Renal Artery Aneurysm in a 13-year-old Child

Primary renal artery aneurysm has been estimated to account for an incidence of 0.015-1% with associated morbidities including renovascular hypertension and rupture. Renovascular hypertension associated renal artery aneurysms in children is not a common disease. In patients with complicated renal vascular disease, renal autotransplantation has been used as an alternative to percutaneous transluminal angioplasty, which may be hazardous in these situations. We report a case of a renal artery aneurysm in a 13-year-old Korean child presenting hypertension detected during school health examination. Preoperative workup demonstrated a 2.8x2.1x1.9 cm saccular aneurysm in the right renal hilum that was not amendable to endovascular repair. A surgical strategy including extracorporeal renal artery reconstruction with autotransplantation was applied in order to restore renal artery anatomy and to treat renovascular hypertension. Immediately he complained of severe right flank pain and postoperative doppler sonography revealed lack of perfusion. On the 5th day after autotransplantation, the patient underwent a transplant nephrectomy. He was well postoperatively and was found to have a normal kidney function and stable blood pressure control without antihypertensive medication. This is the first pediatric case of renal artery aneurysm in Korea who underwent extracorporeal repair followed by autotransplantation failure. More pediatric cases with renal artery aneurysm should be reported to identify therapeutic outcome and long term prognosis.

Hybrid Treatment of Coexisting Renal Artery Aneurysm and Abdominal Aortic Aneurysm in a Gallbladder Cancer Patient

Renal artery aneurysm (RAA) is uncommon, and the coexistence of an abdominal aortic aneurysm (AAA) is an extremely rare condition with potentially high life-threatening mortality in case of rupture. Aneurysms can be treated by endovascular intervention or open surgery. Although most of aneurysms are treated by endovascular intervention, open surgery is often necessary for RAAs associated with the proximal renal bifurcation or the branches in the distal renal arteries. We report a rare case of coexisting RAA with AAA treated by hybrid method, consisting of endovascular aneurysm repair for AAA and open surgery for RAA located adjacent to the distal branches of the renal artery.

Ruptura espontánea de aneurisma de arteria renal duranteel embarazo: reporte de caso / Spontaneous rupture of renal arterial aneurism during pregnancy: case report

Se presenta un caso de ruptura espontánea del aneurisma de la arteria renal. Paciente de 30 años con embarazo de 30 semanas y dolor de fuerte intensidad, de aparición súbita y de carácter punzante en cuadranteinferior izquierdo. La exploración del útero y los anexos no se observaron anomalías macroscópicas. Se observó sangre en el espacio retroperitoneal izquierdo. La arteria renal izquierda mostraba una apertura que se comunicaba con un saco aneurismático, por lo que se realizó la nefrectomía

A case of spontaneous rupture of renal artery aneurysm is described in a 30 years-old patient with a 30 weeks pregnancy who consulted for presenting severe and acute pain in left inferior quadrant. Uterus and both adnexa examination did not show macroscopical anomalies. There was observed blood in left retroperitoneal space. Left renal artery showed and opening that comuncate to secular aneurysm, nephrectomy was done

Surgically Treated Renal Artery Aneurysm / 대한혈관외과학회지

Renal artery aneurysm is a rare disease that can be found on routine examination. With development of interventional radiology, most cases of renal artery aneurysm had been treated with coil and stents. However, the use of coil and stents has a higher morbidity than surgical treatment and is anatomically restricted. A 62-year-old female had a scheduled visit the hospital to evaluate ongoing hypertension and upper abdominal pain. On computed tomography scan, a small aneurysmal dilatation was detected in the mid-portion of the left renal artery. We tried to correct this problem using radiologic intervention. However, the attempt had to be aborted because of the anatomical complexity of aneurysm location. During the operation, the aneurysmal sac was found to be located between the inferior border of pancreas and the upper border of the renal vein. After resection of the aneurysm, both ends of the artery were anastomosed directly without using any patches. The patient was discharged without any complications related to the operation. Radiologic intervention is now replacing traditional vascular surgery. However, there are limitations in conditions of anatomical difficulty and complexity.

Rupture of Renal Artery Aneurysm Misdiagnosed as Postpartum Retroperitoneal Hematoma / 대한주산의학회잡지

Aneurysms in the renal artery are relatively rare and predominately asymptomatic. Histological data estimate that renal artery aneurysms (RAAs) are found in 0.1% of the general population. The most catastrophic complication of RAA is rupture, which occurs in less than 3% of patients. Nearly 30 cases of rupture of RAA (RRAA) during pregnancy have been reported in the international literature, but no RRAA diagnosed after labor has been reported. We report on the first case of acute RRAA after labor, which was initially misdiagnosed as postpartum retroperitoneal hematoma, and provide a brief review of the literature.

Aneurisma de artéria renal em rim transplantado: reparo ex vivo e reimplante do enxerto / Renal artery aneurysm in a transplanted kidney: ex vivo graft repair and reimplantation

Aneurisma verdadeiro de artéria renal em rim transplantado é ocorrência rara. As possibilidades de tratamento dependem do tamanho, da localização do aneurisma e da clínica apresentada pelo paciente. Descreve-se um caso de aneurisma gigante de artéria renal em rim transplantado que recebeu tratamento ex vivo e reimplante na fossa ilíaca direita. Detalhes do procedimento cirúrgico são descritos.

True aneurysm of a renal artery in a transplanted kidney is a rare occurrence. Treatment options depend on size and location of the aneurysm and the patient's clinical condition. We report a case of a giant aneurysm of the renal artery in a transplanted kidney that was treated ex vivo and reimplanted in the right iliac fossa. Details of the surgical procedure are described.

Kidney Transplantation after ex vivo Repair of an Aneurysm of the Donor Renal Artery / 대한이식학회지

Kidney transplantation, particularly from a living donor, is the treatment of choice for most patients with end-stage renal disease. The superior results achieved with kidney transplantation from living donor. We report a case of transplantation using a kidney with renal arterial aneurysm from a 49-year-old living donor to her 51-year-old brother. A preoperative CT angiogram in a donor candidate showed the right kidney with 6 mm sized saccular aneurysm involves the proximal portion of anterior segmental artery. The kidney was removed by a hand-assisted laparoscopic nephrectomy. After ex vivo aneurysmectomy, the graft was transplanted into the right iliac fossa. The total ischemic time was 62 minutes, and the urine flow was started immediately after declamping. If there are multiple donor candidates of same condition, donor with unilateral renal artery aneurysm should be chosen for transplant. The use of those grafts is safe for both recipients and donors.

A case of percutaneous coil embolization of renal artery aneurysm / 대한내과학회지

Renal artery aneurysms are relatively uncommon, being found in approximately 0.09% of the general population. They are usually found incidentally during investigation of patients with microscopic hematuria or high blood pressure. Rupture is the most lethal complication of renal aneurysms. Surgical treatment had been common for these aneurysms. We report a case of about 2-cm-diameter renal artery aneurysm successfully treated by embolization with non-detachable platinum coil.

Spontaneous Rupture of Renal Artery Aneurysm in a Patient with Untreated Hypertension / 대한신장학회잡지

Spontaneous rupture of renal artery aneurysm is a rare, but life threatening complication with high mortality. The etiology of non-traumatic renal artery aneurysm is fibromuscular dysplasia, atherosclerosis, vasculitis, and pregnancy. We here report a case of spontaneous rupture of renal artery aneurysm in a patient with untreated hypertension. A 39-year-old non-pregnant woman complained of sudden onset of right flank and lower quadrant abdominal pain. Ultrasonography showed large fluid collection in right lower abdomen. Emergency laparotomy demonstrated huge retroperitoneal hematoma due to spontaneous rupture of right renal artery aneurysm. Microscopic examination of the aneurysmal wall revealed intimal hyperplasia without atherosclerotic change.

Renal Artery Aneurysms: Report of 8 cases and review of literature

Renal artery aneurysm is a rare disease and a uniommon cause of renovascular hypertension. The estimated incidence of renal artery aneurysm in the normal population varies from 0.09% to 0.3%. Eight renal artery aneurysms that we experienced between February 1986 and January 1998 were reviewed. All were saccular including one iatrogenic pseudoaneurysm after balloon angioplasty for fibromuscular renal artery stenosis. The ages ranged from 20 through 66 years with the mean age of 42 years and there was no difference in sex distribution. Of the 8 patients, 6 were diagnosed on the basis of arteriography, 1 on the basis of computed tomography, and 1 at a urologic surgery. There was no aneurysm ruptured spontaneously. The aneurysm size ranged from 1.5 cm through 12.5 cm with the mean size of 4.1 cm, but 7 aneurysms were not greater than 5 cm in size. In 4 patients (50%) the aneurysm were calcified. Only four had symptoms such as pain or discomfort on trunk. 2 patients had associated renovascular hypertension. 5 patients (63%) underwent operation i.e. 3 arterial reconstruction and 2 nephrectomy that was inevitable due to complicated location or surrounding adhesion enough to unappreciable of vascular reconstruction. One associated hypertension was cured with operation, another renovascular hypertention was not resolved by operation. There was no operative mortality. This study reveals that the saccular type is predominant and spontaneous rupture is uncommon feature in renal artery aneurysm.

Spontaneously Ruptured Congenital Arteriovenous Malformation of Kidney with Renal Artery Aneurysm / 대한비뇨기과학회지

Arteriovenous malformations of the kidney with renal artery aneurysm are rare. Rupture of an congenital arteriovenous malformation in the kidney has been reported only in 4 cases and all cases were accompanied with pregnancy. We present a case of spontaneously ruptured congenital arteriovenous malformation of the kidney with renal artery aneurysm in a 39-year-old man with literature review.

Renal Artery Aneurysm: Report of Two Cases / 대한비뇨기과학회지

Aneurysm was the first disease of the renal artery to be recognized by Rouppe on 1770, and until selective renal angiography came into vogue, it was considered a rare occurrence. We had experienced 2 cases of renal artery aneurysm that one case was found intraoperatively by chance and the other was confirmed with selective renal angiography. We report 2 cases with review of the literature.