Aneurysms of the Renal Artery
Section snippets
Epidemiology and Etiology
ANEURYSMS FOUND WITHIN the renal arterial bed are uncommon and predominately asymptomatic. Although the true incidence is unknown, historical data estimate that renal artery aneurysms (RAAs) are found in 0.1% of the general population.1 These particular aneurysms are reported to be more frequent in women than men, affect the right side more than the left, are less frequently bilateral, and typically solitary.2 Interestingly, the majority of RAAs are saccular rather than fusiform, and frequently
Surgical Options
The surgical options for treating RAAs are varied and primarily dependent on the experience of the operator and anatomic configuration of the aneurysm. Because most aneurysms in the renal arterial bed are saccular, they can be treated with aneurysmectomy and either primary repair or bypass.15 An alternative approach for treating aneurysms within the kidney includes ex vivo repair. Every attempt should be made to preserve as much of the kidney as possible; however, in rare cases, a complete
Endovascular Options
Endovascular treatment of RAAs has been in rapid evolution. Until recently, these options were limited primarily to occlusive embolization of the parent artery; however, advances in lower profile and more trackable devices now offer a full range of alternatives. As with the open surgical choices, endovascular attempts to treat RAAs are dependent on the skill of the interventionalist and anatomic characteristics of the lesions. Potential interventions include stent-graft exclusion of the
Summary
Renal aneurysms are uncommon but can be problematic with the recognized risks of rupture, hypertension, and renal infarction. Current indications for treatment of RAAs include presence of symptoms, asymptomatic aneurysm 2.0 cm or larger in men and postmenopausal women, and all aneurysms in women of childbearing age. Treatment encompasses both standard open surgical reconstructive efforts and endoluminal interventions, making the need for nephrectomy a rare event today.
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