Renal artery aneurysm

Bisschops RH, Popma JJ, Meyerovitz MP (2001) Treatment of fibromuscular dysplasia and renal artery aneurysm with use of a stent-graft. J Vase Interv Radiol 12 757-760... 

Pershad A, Heuser R (2004) Renal artery aneurysm successful exclusion with a stent graft. Catheter Cardiovasc Interv 61 314-316... 

Schneidereit NP, Lee S, Morris DC, Chen JC (2003) Endovascular repair of a ruptured renal artery aneurysm. J Endovasc Ther 10 71-74... 

Tan WA, Chough S, Saito J, Wholey MH, Eles G (2001) Covered stent for renal artery aneurysm. Catheter Cardiovasc Interv 52 106-109... 

Liguori G, Trombetta C, Bucci S, Pozzi-Mucelli F, Bernobich E, Belgrano E (2002) Percutaneous management of renal artery aneurysm with a stent-graft. J Urol 167 2518-2519... 

Fibromuscular dysplasia (FMD) is an inherent arterial wall abnormality that classically affects the media of the renal arteries and can be associated with renal artery aneurysms. Several subtypes of FMD have been described and the disorder can affect other medium-sized vessels including the carotid, vertebral, brachial, and visceral arteries. For the angiographer, FMD has the classic beaded appearance often described as a string of pearls. Both aneurysms and dissections can be seen with this disorder. The treatment for FMD is angioplasty of the intraluminal webs, which results in significant remodeling. 

Renal artery aneurysms can also be seen in patients with angiomyolipomas (AMLs) (Fig. 8.2). Classically, AMLs occur in elderly females and patients with tuberous sclerosis. The entire lesion can often be embolized in addition to coiling the aneurysms. A combination of coils and PVA or simply ethanol infusion with a balloon occlusion catheter can be performed as definitive treatment or if surgical resection is anticipated. 

Martin RS 3rd et al. (1989) Renal artery aneurysm selective treatment for hypertension and prevention of rupture. J Vase Surg 9 26-34... 

Poutasse EF (1966) Renal artery aneurysms their natural history and surgery. J Urol 95 297-306... 

McCarron JP Jr, Marshall VF, Whitsell JC 2nd (1975) Indications for surgery on renal artery aneurysms. J Urol 114 177-180... 

Hubert JP Jr, Pairolero PC, Kazmier FJ (1980) Solitary renal artery aneurysm. Surgery 88 557-565... 

Schorn B et al. (1997) Kidney salvage in a case of ruptured renal artery aneurysm case report and literature review 1. Cardiovasc Surg 5 134-136... 

Bruce M, Kuan YM (2002) Endoluminal stent-graft repair of a renal artery aneurysm. J Endovasc Ther 9 359-362... 

Rundback JH et al. (2000) Percutaneous stent-graft management of renal artery aneurysms. J Vase Interv Radiol 11 1189-1193... 

Other rare urologic complications of WG include renal artery aneurysms (73,74), renal masses (75,76), necrotizing vasculitis involving the ureters (74), ureteral stenosis (72,77), penile necrosis (73) or ulcers (77), acute urinary retention (72), bladder pseudotumor (77), and involvement of the prostate (3,78). 

The endovascular procedure is most frequently used to treat infrarenal AAAs that are a leading cause of death in the older population, As our population ages, we will encounter AAAs more frequently than ever before. An aneurysm is defined by a size greater than 5 cm or 2.5 times the normal diameter of the native artery. Most aneurysms begin below the renal arteries and end close to the iliac bifurcation. More complicated AAAs exist involving the suprarenal aorta and visceral vessels and extending into the iliac arteries. The prevalence of AAAs is 3% to 10% for patients older than 50 years (I). They occur more frequently in men and reach a peak incidence close to the age of 80 years. AAA rupture is associated with an 80% to 90% mortality rate and therefore the focus of AAA treatment is on intervening before the aneurysm ruptures elective repair has mortality rate of less than 5%. 

A 62-year-old hypertensive man with renal artery stenosis, an adrenal adenoma, peripheral artery disease, and an abdominal aortic aneurysm developed a hypertensive crisis with chest pain. He was treated with nitrates, heparin, aspirin, and nicardipine, which were afterwards replaced by diltiazem 200 mg/day, because of persistent chest pain. He developed atrioventricular block 2 hours after the second dose of diltiazem, and was successfully treated with a pacemaker. 

A 64-year-old obese man with a history of radiocontrast-induced nephropathy had an MRI scan, which confirmed the presence of an aortic aneurysm from just below the renal arteries to the aortic bifurcation (31). Percutaneous stenting of the aortic aneurysm... 

Routh WD, Keller FS, Gross GM (1990) Transcatheter thrombosis of a leaking saccular aneurysm of the main renal artery with preservation of renal blood flow. AJR Am J Roentgenol 154 1097-1099... 

A type II endoleak corresponds to the retrograde filling of the aneurysm mainly from lumbar arteries and/or IMA but also in rare situations from sacral, gonadal or accessory renal artery (Figs. 14.3,14.4). 

The mortality rate at 24 months was 86% however, none of these deaths were complications from aneurysms. The majority of the endoleaks found in follow-ups were type II. There was one example of a type III endoleak resulting from the fenestration. However, this fenestration had not been stented due to renal stenosis and a resulting inability to catheterize. The four incidences of renal artery occlusion found in follow-ups did not result in a need for hemodialysis. Overall there was a decrease in renal artery performance in 10% of patients (Ricco, 2010 Amiot 2010). 

Therefore, methods such as hybrid procedures, sandwiches, chimneys and snorkels, and on-site and in situ fenestrations have been developed. Hybrid procedures involve open surgery to create bypasses to the renal and mesenteric arteries, followed by covering all the branches with a conventional stent graft so as to extend the landing zone. Chimneys or snorkels involve placing a parallel, smaller sized covered stent into the renal arteries so that blood flows to the kidneys. However, there is concern that endoleaks will cause blood to flow between the aortic stent-graft and the renal chimney. There is a similar concern when more than one bifurcated device is inserted or sandwiched in the same aneurysmal sac so as to provide blood flow to several extensions simultaneously. The body of such devices needs to take on a D shaped cross-section so as to avoid endoleaks between the devices and the aneurysmal sac. 

The same holds true for the visualization of the abdominal aorta and for stent graft planning and for post-operative control for endo-leakage (Bartolozzi et al. 1998). Prior to surgery, CTA may be able to display the origin of the renal arteries and the distance from the abdominal aneurysm, as well as the course of the iliac arteries. 

Highly important lesions are usually defined as lesions that require surgical treatment, medical intervention, and/or further investigation during that patient care visit. Examples include indeterminate solid organ masses, previously unknown abdominal aortic aneurysms 3 cm or larger, aneurysms of the splenic or renal arteries, indeterminate chest nodule, adenopathy, and pancreatic masses. 

Fig. 23.4. Modified classification of thoracic and abdominal aortic aneurysms by Crawford. Type I distal of the left subclavian artery as far as the renal arteries type II distal of the left subclavian artery, extending below the renal arteries type III from the sixth thoracic vertebral body, extending below the re-...

Majwal TK, Ismail A, Alaqily R (2002) Renal artery stenosis associated with saccular aneurysm and arterio-venous fistula. J Invasive Cardiol 14 411-413... 

Typically pseudoaneurysm formation in the renal artery distribution is iatrogenic or traumatic. Other causes of aneurysm formation include fihromuscu-lar dysplasia, polyarteritis nodosa, amphetamine abuse, angiomyolipoma in the presence or absence of tuberous sclerosis, and neurofibromatosis. 

Panayiotopoulos YP, Assadourian R, Taylor PR (1996) Aneurysms of the visceral and renal arteries. Ann R Coll Surg Engl 78 412-419... 

Hageman JH et al. (1978) Aneurysms of the renal artery problems of prognosis and surgical management. Surgery 84 563-572... 

Harrow BR, Sloane JA (1959) Aneurysm of renal artery report of five cases. J Urol 81 35-41... 

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