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      Endovascular Treatment of Ruptured Renal Artery Aneurysm: A Case-Based Literature Review

      case-report
      Author(s): 1 , , 2 , 3 , 4
      Publication date (Electronic):
      Journal: Case Reports in Medicine
      Publisher: Hindawi

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          Abstract

          Renal artery aneurysms are extremely uncommon with a reported incidence of less than one percent in general population. They are being more frequently detected due to increasing availability and use of abdominal imaging. Renal artery aneurysm rupture is an extremely unusual cause of acute flank pain with hemodynamic instability. Given the rarity of diagnoses, clinicians may not consider and address this ruptured renal artery aneurysm early which can potentially lead to adverse clinical outcomes. We report the case of a 55-year-old male who presented with retroperitoneal bleeding from a ruptured aneurysm of the interlobular branch of renal artery. He was endovascularly treated with coil embolization. We have also reviewed the inherent literature.

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          Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients.

          W G Upchurch, P Henke, Brenna L Greenfield … (2001)
          To define the relevance of treating renal artery aneurysms (RAAs) surgically. Most prior definitions of the clinical, pathologic, and management features of RAAs have evolved from anecdotal reports. Controversy surrounding this clinical entity continues. A retrospective review was undertaken of 168 patients (107 women, 61 men) with 252 RAAs encountered over 35 years at the University of Michigan Hospital. Aneurysms were solitary in 115 patients and multiple in 53 patients. Bilateral RAAs occurred in 32 patients. Associated diseases included hypertension (73%), renal artery fibrodysplasia (34%), systemic atherosclerosis (25%), and extrarenal aneurysms (6.5%). Most RAAs were saccular (79%) and noncalcified (63%). The main renal artery bifurcation was the most common site of aneurysms (60%). RAAs were often asymptomatic (55%), with a diagnosis made most often during arteriographic study for suspected renovascular hypertension (42%). Surgery was performed in 121 patients (average RAA size 1.5 cm), including 14 patients undergoing unilateral repair with contralateral RAA observation. The remaining 47 patients (average RAA size 1.3 cm) were not treated surgically. Operations included aneurysmectomy and angioplastic renal artery closure or segmental renal artery reimplantation, aneurysmectomy and renal artery bypass, and planned nephrectomy for unreconstructable renal arteries or advanced parenchymal disease. Eight patients underwent unplanned nephrectomy, being considered a technical failure of surgical therapy. Dialysis-dependent renal failure occurred in one patient. There were no perioperative deaths. Late follow-up (average 91 months) was available in 145 patients (86%). All but two arterial reconstructions remained clinically patent. Secondary renal artery procedures included percutaneous angioplasty, branch embolization, graft thrombectomy, and repeat bypass for late aneurysmal change of a vein conduit. Among 40 patients with clearly documented preoperative and postoperative blood pressure measurements, 60% had a significant decline in blood pressure after surgery while taking fewer antihypertensive medications. Late RAA rupture did not occur in the nonoperative patients, but no lessening of this group's hypertension was noted. Surgical therapy of RAAs in properly selected patients provides excellent long-term clinical outcomes and is often associated with decreased blood pressure.
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            Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas.

            Zhongming Zhang, Min Yang, Li Song … (2013)
            To describe our experience with the treatment of renal artery aneurysms (RAAs) and renal arteriovenous fistulas (RAVFs) by transcatheter techniques with special consideration given to indications, technical options, and complications.
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              Endovascular vs open repair of renal artery aneurysms: outcomes of repair and long-term renal function.

              Joseph Ricotta, Nikolaos Tsilimparis, James G Reeves … (2013)
              Endovascular treatment (ER) of renal artery aneurysms (RAA) has been widely used recently due to its assumed lower morbidity and mortality compared with open surgery (OS). The purpose of this study was to investigate the outcomes of OS and ER, and compare long-term renal function.
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                Author and article information

                Contributors
                Yub Raj Sedhai:
                ORCID: http://orcid.org/0000-0002-1755-5489
                Journal
                Journal ID (nlm-ta): Case Rep Med
                Journal ID (iso-abbrev): Case Rep Med
                Journal ID (publisher-id): CRIM
                Title: Case Reports in Medicine
                Publisher: Hindawi
                ISSN (Print): 1687-9627
                ISSN (Electronic): 1687-9635
                Publication date Collection: 2019
                Publication date (Electronic): 6 February 2019
                Volume: 2019
                Electronic Location Identifier: 3738910
                Affiliations
                1Clinical Assistant Professor of Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
                2Resident, Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
                3Nuclear Cardiology Clinical and Research Fellow, Massachusetts General Hospital Corrigan Minehan Heart Center, Harvard Medical School, Boston, MA, USA
                4Resident, Internal Medicine, Interfaith Medical Center, Brooklyn, NY, USA
                Author notes

                Academic Editor: Masahiro Kohzuki

                Author information
                http://orcid.org/0000-0002-1755-5489
                Article
                DOI: 10.1155/2019/3738910
                PMC ID: 6381552
                SO-VID: 309aee62-6368-416e-8070-2b5403327c35
                Copyright © Copyright © 2019 Yub Raj Sedhai et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 September 2018
                Date revision received : 16 December 2018
                Date accepted : 20 January 2019
                Categories
                Subject: Case Report

                Data availability:

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