Treatment of renal artery aneurysm by ex-situ repair and autotransplantation: a nationwide cohort study.

ABSTRACT

Introduction Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aims to investigate the safety and efficacy of ex-situ repair and autotransplantation for endovascularly untreatable RAA. Methods A retrospective nationwide cohort study was conducted in RAA patients undergoing ex-situ repair and autotransplantation in the Netherlands. Surgical techniques, postoperative complications, and graft outcomes were assessed. Results Ex-situ repair was performed in 9 patients with 11 RAAs. Eight RAAs were located at the first bifurcation, one on the main trunk, one on the first branch, and one on the second branch. Nephrectomy was performed via laparoscopy (n=7), robotic-assisted laparoscopy (n=1) and laparotomy (n=1). Postoperative complications were recorded in four patients, including bowel obstruction, delirium, pneumonia and hydronephrosis due to double-J dislocation. Median estimated glomerular filtration rate (eGFR) was 83 ml/min/1.73m2 pretransplant and 88 ml/min/1.73m2 posttransplant. By an average follow-up of 3 years, two patients had died due to lung adenocarcinoma and stroke, while all autotransplanted kidneys had good patency and remained functional. Conclusions Ex-situ repair and autotransplantation are safe and feasible for endovascularly untreatable RAA cases. Larger cohorts with longer follow-up periods are necessary to further evaluate the role of this surgical approach.