Case ReportPercutaneous Stent-Graft Management of Renal Artery Aneurysms
Section snippets
• Case 1
A 71-year-old woman with a 20- year history of hypertension presented with a complaint of low back pain radiating to the right flank for several months. She denied any hematuria and had no history of trauma or surgery. She was taking metoprolol and diazoxide. On admission, her blood pressure was 160/90 mm Hg. The remainder of her physical examination was unremarkable, and no subcostal bruits were auscultated. Her serum creatinine level was 0.9 mg/dL. Radiography of the lumbar spine did not show
DISCUSSION
Circumstances necessitating repair of RAA have been debated, with the current consensus including:
- 1.
RAA .2.0–2.5 cm in greatest diameter,
- 2.
RAA causing renovascular hypertension,
- 3.
dissecting RAA,
- 4.
RAA causing local symptoms (ie, flank pain, hematuria),
- 5.
RAA occurring in women of childbearing age with potential for pregnancy, as a result of an increased risk of rupture during pregnancy,
- 6.
RAA associated with functionally significant renal artery stenosis,
- 7.
RAA with distal embolization, and
- 8.
RAA with
CONCLUSION
Percutaneous techniques may be used as an alternative to surgery for the elective management of symptomatic or enlarging RAA. The angiographic pattern of the aneurysm and its feeding artery helps determine the optimal method of treatment. Stentgraft placement can be safely performed for the exclusion of saccular RAA arising from the main renal artery or proximal portion of large segmental arteries. Future devices are likely to reduce the technical difficulties associated with this procedure.
References (16)
- et al.
Renal artery aneurysm: selective treatment for hypertension and prevention of rupture
J Vasc Surg
(1989) - et al.
Custom bifurcated stent-graft for abdominal aortic aneurysms: initial experience
JVIR
(1999) - et al.
Renal artery aneurysms
Urology
(1992) - et al.
Rupture of abdominal aortic aneurysm previously treated by endovascular stent graft
J Vasc Surg
(1998) - et al.
Aneurysms of the renal artery: problems of prognosis and surgical management
Surgery
(1978) - et al.
Renal artery aneurysm. Natural history and prognosis
Ann Surg
(1983) - et al.
Natural history of renal artery aneurysm elucidated by repeated angiography and pathoanatomical studies
Eur Urol
(1985) - et al.
Solitary renal artery aneurysm
Surgery
(1980)