Aneurysms of the Renal Artery

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Increasing utilization of diagnostic imaging studies has provided newer insight into our current knowledge of visceral artery aneurysms. Because many are “silent,” an appreciation of the true incidence and natural history of these nonaortic arterial aneurysms is only recently being understood. Historical data suggest that renal artery aneurysms (RAAs) occur in approximately 0.1% of the general population. Recognized complications associated with RAAs include renovascular hypertension, renal artery thrombosis, infarction from distal embolization, arteriovenous fistula formation, and, the most dreaded risk, rupture. Unfortunately, there remains continued controversy about the indications for and mode of treating RAAs. This article attempts to shed some light on the contemporary management options in view of advances in percutaneous endoluminal interventions.

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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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