Ruptured renal artery aneurysm mimicking hydronephrosis in pregnancy

[Spontaneous false aneurysm of the extracranial internal carotid artery - during pregnancy]

Extracranial carotid false aneurysms are rare but serious because of the high risk of rupture and thromboembolic ischemic strokes. Although hemodynamic and hormonal physiological changes in pregnant women may favor arterial rupture and the development of false aneurysms, only one case of extracranial carotid false aneurysm related to pregnancy has been reported in the literature. Surgical repair is still the treatment of choice of these lesions. We report a case of spontaneous false aneurysm of the extracranial internal carotid artery occurring at the end of pregnancy. The surgical procedure consisted in resection of the false aneurysm with interposition of a prosthetic graft. The follow-up was uneventful.

Ruptured renal artery aneurysm in pregnancy and puerperium: literature review of 53 cases

PURPOSE

To summarize and define the most appropriate diagnostic methods and therapeutic options for ruptured renal artery aneurysms in pregnancy based on rarely published data.

METHODS

Literature searches of English-, German-, Spanish-, and Italian-language articles were performed in PubMed (1946-2018), PubMed Central (1900-2018) and Google Scholar. The search terms included renal artery aneurysm, renal artery rupture, pregnancy, puerperium, nierenarterienaneurysma, schwangerschaft, wochenbett, aneurisma de la arteria renal, el embarazo, puerperio, aneurisma dell'arteria renale and gravidanza. Additional studies were identified by reviewing reference lists of retrieved studies.

RESULTS

Fifty-three cases were collected. The average maternal age was 31 ± 6 years; 71.4% were multiparous and significantly older than primiparas. The majority presented in the third trimester (62.3%), followed by second (20.7%) and the first (5.7%), while 11.3% presented postpartum. All postpartum patients presented during the first week postpartum and 50% during the first 24 h postpartum. Parity was not associated with the trimester of presentation. The left renal artery was affected slightly more frequently (58.5% vs. 41.5%). There were no differences in the affected side according to trimester of presentation, including postpartum. 25 out of 53 cases underwent ipsilateral nephrectomy (47.1%) and 18 underwent aneurysm repair or coil embolization (34.0%). There was no difference in maternal (25.8%) vs. 4 (18.1%) and fetal mortality according to the side of rupture. There were no differences in the distribution of maternal or fetal mortality frequency according to the trimester of presentation.

CONCLUSIONS

The clinical presentation is easily confused with more common conditions and time to diagnosis is often delayed. Diagnostic delay is associated with high maternal and fetal mortality. Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with acute and severe flank pain, especially if followed by a drop in blood pressure. Early diagnosis and immediate intervention are important for achieving better maternal and fetal outcomes. There are several methods of managing asymptomatic or ruptured renal artery aneurysm during pregnancy although no established guidelines exist.

A large aneurysm in an arterio-venous fistula for renal access in a pregnant young woman

Pregnancy is known to increase the risk of aneurysm formation, likely by a combination of histological changes in vessel walls associated with the hormones of pregnancy and the haemodynamic changes to the circulation. To our knowledge this is the first case of a pregnant woman with a brachial-cephalic arterio-venous fistula (AVF) that had never been needled for haemodialysis, yet became hugely aneurysmal during her pregnancy.

[Rupture of renal artery aneurysm into the renal pelvis]

We report a case of ruptured renal artery aneurysm into the renal pelvis. A 48-year-old woman presented with complaints of gross hematuria and right back pain. Abdominal ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the aneurysm, which was 5 x 5 cm in diameter. Enhansed CT revealed blood flow from the renal artery aneurysm into the renal pelvis. Radical nephrectomy was performed. Rupture of renal artery aneurysm into the renal pelvis is the 3rd case in the Japanese literatures. Pathogenesis and management of this rare condition are discussed.

Extracranial carotid aneurysm related to pregnancy

Carotid aneurysms are rare, and pregnancy-related carotid aneurysms are rarer still. We report the case of an extracranial carotid aneurysm related to pregnancy. It was noted in the 20th week of gestation, and was uncomplicated. Surgery was successfully performed urgently to preempt embolism or rupture. The patient had a full-term normal delivery. The graft is patent, and the patient has no symptoms at 28-month follow-up. To the best of our knowledge, this case represents the first successful repair of an extracranial carotid aneurysm during pregnancy.