ABSTRACT
Renal artery aneurysms are rare. Indications for management include size > 3 cm, female gender within childbearing age, pain, hematuria, medically refractory hypertension, thromboembolism, dissection, and rupture. Management options include endovascular, open repair, and ex vivo approaches. A 43-year-old female with a history of polycystic kidney disease, solitary kidney, and uncontrolled hypertension was found to have a proximal large renal aneurysm on imaging. The patient underwent an in situ open aneurysm resection, temporary shunt insertion, and patch repair with good postoperative outcomes. Whereas previous studies showed the success of ex vivo repair and autotransplantation in large aneurysms with solitary kidneys, our case demonstrated that in situ open repair and patch with the use of a temporary shunt is a feasible and effective option. In a patient with a solitary kidney and large proximal renal artery aneurysm, an in situ open approach and patch repair with shunt insertion should be considered.
ABSTRACT
OBJECTIVE: The purpose of this study is to report the results of a novel procedure for femoral-distal bypass grafting using a composite graft with an adjunctive remote popliteal fistula distal to the prosthetic portion of the graft. This reconstruction was developed for use in limb salvage in the absence of satisfactory autogenous vein. METHOD: Data were collected prospectively on all patients undergoing this procedure from January 1, 1993 to December 31, 1999. Graft patency was determined from follow-up duplex scanning. Patient survival was determined by clinic follow-up. RESULTS: A total of 43 procedures were performed in 38 patients. In 34 patients, 72 previous arterial operations had been previously performed on the ipsilateral limbs. There were 20 men and 18 women with a mean age of 72 years. The indication for surgery was limb salvage in all, with rest pain in 30, and tissue loss in 13. The outflow artery was the below-knee popliteal artery in 10 and a tibial artery in the remainder. Operative mortality was 6.8%. Mean follow up was 26.9 months. The primary patency was 54% at 12 months. Six reconstructions were revised for a primary assisted patency of 60% at 16 months. Secondary patency was 69% at 16 months. Patient survival was 62% at 2 years and 26% at 5 years. CONCLUSIONS: The technique of composite grafting with remote popliteal arteriovenous fistula may be a useful alternative in infragenicular bypass when a satisfactory autogenous vein is not available.
