Is endovascular main renal artery embolization with kidney sacrifice a safe option? A case report of renal artery aneurysm

Abstract Background A renal artery aneurysm is a rare clinical presentation that can be found incidentally on imaging or during workup for refractory hypertension. Its presentation can be similar to that of a renal artery pseudoaneurysm, but the etiologies of the two vascular lesions differ. We present a patient who had an incidental finding of a large renal artery aneurysm that was managed with endovascular embolization. We also describe the literature surrounding the etiology, presentation and management of both renal artery aneurysms and renal artery pseudoaneurysms. Case presentation A 62-year-old man was referred to a urologic oncologist for workup of a newly found renal mass. Initial imaging with computed tomography showed a homogenous, well-circumscribed mass arising from the right kidney. Further evaluation with Doppler ultrasonography demonstrated pulsatile flow within the renal mass that was concerning for a renal artery pseudoaneurysm. The patient initially underwent a diagnostic angiogram by interventional radiology and was found to have a true renal artery aneurysm. Interventional radiology considered placement of a covered stent or angioembolization, but treatment was deferred due to concern for compromising the patient’s renal function. Patient was subsequently transferred to a neighboring hospital for management by vascular surgery. After considering both open surgical and endovascular approaches, the patient ultimately underwent angioembolization of the renal artery aneurysm. Short-term follow-up showed successful exclusion of the aneurysm with minimal adverse effects to the patient. Conclusions Our case report documents a unique case of an incidentally found large renal artery aneurysm that was successfully managed with endovascular embolization. Renal artery aneurysms and renal artery pseudoaneurysms, which can present similarly on imaging, are important diagnostic considerations in a patient presenting with a new renal mass. While open surgical approaches can be used to repair aneurysms, endovascular approaches using stenting or angioembolization are safe and effective options for treating renal aneurysms and renal pseudoaneurysms.

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An Experience with Placement of a Stent-Graft in a Renal Artery Aneurysm via the Brachial Artery: A Case Report

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2005.53.6.417 ◽

2005 ◽

Vol 53 (6) ◽

pp. 417

Author(s):

Mi Hyun Park ◽

Byung Seok Shin ◽

Moonsang Ahn

Keyword(s):

Case Report ◽

Renal Artery ◽

Stent Graft ◽

Brachial Artery ◽

Artery Aneurysm ◽

Renal Artery Aneurysm

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Lumbar artery aneurysm

VASA ◽

10.1024/0301-1526.38.1.73 ◽

2009 ◽

Vol 38 (1) ◽

pp. 73-75

Author(s):

Flügel ◽

Henschke ◽

Peck ◽

Neumann ◽

Zeller

Keyword(s):

Case Report ◽

High Resolution ◽

Aortic Aneurysm ◽

Renal Artery ◽

Rare Case ◽

Artery Aneurysm ◽

Renal Artery Aneurysm ◽

Lumbar Artery ◽

Accessory Renal Artery ◽

Infrarenal Aortic Aneurysm

The purpose of this report is to present a rare case of lumbar artery aneurysm. We report the case of a 54-years-old male patient who was misdiagnosed over years having a chronic infrarenal aortic aneurysm. A 64-slice CT at our institution revealed a large lumbar artery aneurysm. The conclusion of this case report is that a lumbar or accessory renal artery aneurysm has to be taken into consideration if there is a localized enlargement of the lower abdominal aorta and a high resolution CT-scan is strongly recommended to make the exact diagnosis.

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Case 16.3

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0402 ◽

2014 ◽

pp. 761-762

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Renal Artery ◽

Splenic Artery ◽

Middle Age ◽

Artery Aneurysm ◽

Visceral Artery ◽

Renal Artery Aneurysm ◽

Women Patients ◽

Wegener Granulomatosis ◽

Main Renal Artery ◽

The Right

43-year-old man with hypertension resistant to medical therapy Focal dilatation of the right renal artery at its bifurcation is seen on VR images from 3D CE MRA (Figure 16.3.1). Renal artery aneurysm Renal artery aneurysms are relatively infrequent, but nevertheless they are the second most common visceral artery aneurysm after splenic artery aneurysms. The estimated incidence on autopsy studies is approximately 0.01%, while an incidence of 0.3% to 1% has been reported for patients undergoing renal angiography. Renal artery aneurysms are most often detected in middle age and are more common in women. Patients are typically asymptomatic. The aneurysms are associated with hypertension in as many as 73% of cases, but it is not always clear whether the aneurysm is the result or the cause of hypertension. Certainly poststenotic dilatation can result from severe renal artery stenosis, and distal embolization from renal artery aneurysms could result in parenchymal loss and activation of the renin-angiotensin cascade. Renal artery aneurysms have several potential causes, but the 2 most common are atherosclerosis and FMD. Both tend to occur most frequently in the main renal artery, at its bifurcation, or in the proximal branches. Aneurysms due to arteritis, such as polyarteritis nodosa, Wegener granulomatosis, and necrotizing angiitis, as well as most posttraumatic aneurysms and pseudoaneurysms, occur within intrarenal arteries. Additional causes include EDS, neurofibromatosis, infection (mycotic), and iatrogenic causes. FMD is discussed more completely in ...

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Ruptured Renal Artery Aneurysm in a Pregnant Woman: Case Report and Literature Review

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1676057 ◽

2018 ◽

Vol 41 (01) ◽

pp. 062-064 ◽

Cited By ~ 1

Author(s):

Adriane Souza ◽

Caio Ueda ◽

Denise Matsubara ◽

João Glir

Keyword(s):

Case Report ◽

Pregnant Woman ◽

Literature Review ◽

Renal Artery ◽

Gestational Age ◽

Artery Aneurysm ◽

Renal Artery Aneurysm ◽

Fetal Risk

AbstractRenal artery aneurysms (RAAs) are rare and usually asymptomatic; ∼ 90% of them are unilateral. Once diagnosed during pregnancy, they may rupture, presenting a high maternal-fetal risk. The present study reports the case of a 32-year-old pregnant woman with a 30-week gestational age and a ruptured unilateral RAA.

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