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Renal Artery Repair with Kidney Autotransplantation for Renal Artery Aneurysms. Eur J Vasc Endovasc Surg 2022; 63:732-742. [DOI: 10.1016/j.ejvs.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/22/2021] [Accepted: 01/16/2022] [Indexed: 11/19/2022]
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2
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Contarini E, Takagi K, Kimenai HJAN, Ijzermans JNM, Furian L, Rigotti P, Minnee RC. Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review. Ann Vasc Surg 2021; 77:349.e5-349.e18. [PMID: 34437957 DOI: 10.1016/j.avsg.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/10/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Renal artery aneurysm (RAA) is a rare vascular disease. Kidney autotransplantation (KAT) is the treatment option when endovascular approach is not available. However, the evidence on KAT for RAA is mostly limited to small case series or reports. Here, we describe our 2 center experience of KAT for RAA, and provide the results of our systematic literature review to evaluate the outcomes. METHODS A retrospective 2 center study was conducted in patients undergoing KAT for RAA between 2010 and 2018. Moreover, a systematic review was performed on medical databases to evaluate the outcomes of KAT for RAA. RESULTS Nine patients were surgically treated at our institutions: eight with laparoscopic nephrectomy (LN), and 1 with open followed heterotopic KAT. All RAAs were ex-vivo reconstructed, and in 3 cases a vein graft was used for reconstruction. There were 2 postoperative major complications including 1 graft loss. In the systematic review, 102 studies with 355 patients were included. In 35 patients (9.9%) a minimal invasive approach was performed. The incidence of postoperative major complications and graft loss was 9.4% and 4.1%. CONCLUSIONS Our experiences showed that laparoscopic approach for nephrectomy followed heterotopic KAT was feasible with good postoperative outcomes. KAT is an effective treatment for RAA when endovascular approach is not feasible for interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
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Affiliation(s)
- Emanuele Contarini
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Kosei Takagi
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hendrikus J A N Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Robert C Minnee
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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DeCarlo C, Boitano LT, Molina RL, Weinberg I, Conrad MF, Eagleton MJ, Dua A. Pregnancy and Preeclampsia Are Associated With Acute Adverse Peripheral Arterial Events. Arterioscler Thromb Vasc Biol 2020; 41:526-533. [PMID: 33054392 DOI: 10.1161/atvbaha.120.315174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Acute peripheral arterial events, such as aortic dissection, carotid artery dissection, vertebral artery dissection, and ruptured renoviseral aneurysms, have been reported during pregnancy in case series, but there is a paucity of population-based data. This study sought to establish pregnancy and preeclampsia as risk factors for acute peripheral arterial events. Approach and Results: All women who gave birth between 1998 and 2020 within a multicenter health care system were identified. Births that occurred in women <18 or >50 years of age were excluded. Primary outcome was any acute peripheral arterial event that was symptomatic or required intervention. Cox regression model was used to evaluate the association between vascular events and pregnancy as a time-varying covariate. The pregnancy exposure period was from the estimated date of conception to 3 months postpartum. There were 277 697 pregnancies (81.3% deliveries, 17.0% abortions, and 1.7% ectopics) among 176 635 women with 1.68 million patient-years of total follow-up (median, 7.9 years; interquartile range, 2.4-16.2). Preeclampsia complicated 5.3% of pregnancies; 67 790 of 225 763 (30.0%) deliveries were delivered by cesarean. Ninety-six acute arterial events occurred during follow-up, of which 24 occurred during pregnancy, including the postpartum period. Pregnancy (hazard ratio, 1.85 [95% CI, 1.01-3.38]; P=0.046) and preeclampsia (hazard ratio, 10.9 [95% CI, 5.24-22.7]; P<0.001) were significant independent predictors of acute arterial events. CONCLUSIONS While taking into account limitations from estimating conception and outcome dates, pregnancy, especially when complicated by preeclampsia, is associated with an increased risk of acute peripheral arterial events.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Laura T Boitano
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (R.L.M.).,Division of Women's Health, Brigham and Women's Hospital, Boston, MA (R.L.M.)
| | - Ido Weinberg
- Fireman Vascular Center (I.W.), Massachusetts General Hospital, Boston.,Department of Medicine, Division of Vascular Medicine (I.W.), Massachusetts General Hospital, Boston
| | - Mark F Conrad
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Matthew J Eagleton
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Anahita Dua
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
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Jayet J, Davaine JM, Tresson P, Verscheure D, Lawton J, Kashi M, Couture T, Gaudric J, Chiche L, Koskas F. Direct Distal Renal Artery Aneurysm Repair. Eur J Vasc Endovasc Surg 2020; 60:211-218. [DOI: 10.1016/j.ejvs.2020.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
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Ahn T, Roberts MJ, Navaratnam A, Chung E, Wood ST. Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818759367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4
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Affiliation(s)
- Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Australia
| | | | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- AndroUrology Centre, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Australia
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Augustin G, Kulis T, Kello N, Ivkovic V. Ruptured renal artery aneurysm in pregnancy and puerperium: literature review of 53 cases. Arch Gynecol Obstet 2019; 299:923-931. [PMID: 30739174 DOI: 10.1007/s00404-019-05087-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/02/2019] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Tomislav Kulis
- Department of Urology, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Nina Kello
- Division of Rheumatology, Northwell Health, 865 Northern Boulevard, Great Neck, NY, 11021, USA
| | - Vanja Ivkovic
- Department of Internal Medicine, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
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Favi E, Cacciola R, Muthuppalaniappan VM, Thuraisingham R, Ferraresso M, Puliatti C. Multidisciplinary management of complicated bilateral renal artery aneurysm in a woman of childbearing age. J Surg Case Rep 2018; 2018:rjy147. [PMID: 29992003 PMCID: PMC6030946 DOI: 10.1093/jscr/rjy147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/12/2018] [Indexed: 12/27/2022] Open
Abstract
Ruptured renal artery aneurysm (RAA) during pregnancy is a rare condition associated with high mortality rates to both the mother and the foetus. We report on a 41-year-old woman at her second trimester who presented with shock to the emergency department as a result of a ruptured left RAA. While the bleeding was successfully treated with angiographic embolization, a contralateral RAA, also at risk of rupture, was discovered. Due to its position on the artery bifurcation, this lesion was considered not suitable for interventional radiology and was therefore managed by hand-assisted retroperitoneoscopic nephrectomy, ex-vivo repair and autotransplantation. This was done in order to preserve renal mass and give our patient a chance of having future pregnancies without risk of rupture. Three years later, her renal function is normal, there is no evidence of recurrence, and more importantly she had two successful and uncomplicated pregnancies.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Roberto Cacciola
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - Raj Thuraisingham
- Nephrology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carmelo Puliatti
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
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Ravari H, Vatanchi A, Pourali L, Afarideh M, Dadgar S. Renal artery aneurysm rupture during post-partum period: A case report. Electron Physician 2017; 9:5138-5141. [PMID: 28979753 PMCID: PMC5614303 DOI: 10.19082/5138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022] Open
Abstract
Renal artery aneurysm has an incidence of lower than one in 1000 of the general population. The risk of aneurysm rupture increases during pregnancy due to hormonal and hemodynamic changes. Therefore, these patients often refer to physicians with abdominal pain that is followed by shock. We report the case of a 41-year-old multiparous woman who was referred with symptoms of epigastric pain and hemorrhagic shock, a week after her vaginal delivery. She was diagnosed with renal artery aneurysm in ultrasonography. The patient underwent laparotomy and nephrectomy so that she was discharged from hospital with a good general health condition. Imaging measures in a timely manner, carried out by qualified individuals considering a patient’s history and clinical situation is very effective in diagnosis and treatment of post-partum abdominal pain.
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Affiliation(s)
- Hassan Ravari
- M.D., Associate Professor of Vascular Surgery, Department of Vascular Surgery, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Atiyeh Vatanchi
- M.D., Assistant Professor of obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Leila Pourali
- M.D., Assistant Professor of obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Malihe Afarideh
- M.D., Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Salmeh Dadgar
- M.D., Assistant Professor of obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
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Kim MJ, Lee KW, Park JB, Kim SJ. Hand-Assisted Laparoscopic Nephrectomy and Auto-Transplantation for a Hilar Renal Artery Aneurysm: A Case Report. Vasc Specialist Int 2017; 33:84-87. [PMID: 28691001 PMCID: PMC5493192 DOI: 10.5758/vsi.2017.33.2.84] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 11/20/2022] Open
Abstract
A 52-year-old man was admitted with an incidentally detected right renal artery aneurysm (RAA). Computed tomographic angiography with three-dimensional reconstruction revealed that the aneurysm was 2.2 cm in diameter and located at the renal hilum. We performed hand-assisted laparoscopic nephrectomy with ex vivo repair of the RAA and auto-transplantation with minimal elongation of Gibson incision. The operation and postoperative course were uneventful. At last follow-up, the patient was alive with a well-functioning auto-transplant. Hand-assisted laparoscopic nephrectomy and auto-transplantation is a useful treatment option for hilar RAA.
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Affiliation(s)
- Min Jung Kim
- Department of Surgery, National Police Hospital, Seoul, Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Editor's Choice - Ex vivo Renal Artery Repair with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Long-term Results of Sixty-seven Procedures. Eur J Vasc Endovasc Surg 2016; 51:872-9. [PMID: 27036374 DOI: 10.1016/j.ejvs.2016.02.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/23/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND To evaluate the long-term outcome of renal revascularization by ex vivo renal artery reconstruction and autotransplantation for renal artery branch aneurysms (RABAs). METHODS Between 1991 and 2015, 67 ex vivo renal artery reconstructions with kidney autotransplantation were performed in 55 adults (mean age 47 years) and 10 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia in 34 patients. Other etiologies were systemic congenital disease in eight patients, spontaneous dissecting aneurysms in five, iatrogenic aneurysms in three, atheromatous aneurysms in two and unknown etiology in 13. Median RABA diameter was 20.5 mm. Fifty-three patients (82%) were hypertensive, 60 had normal renal function and no patient was on hemodialysis. Seven patients (11%) were operated on after failure of an endovascular procedure. The mean number of renal artery branches repaired per patient was 3.5 and multiple aneurysms were treated in 14 patients (22%). The hypogastric artery was used in 41 patients, the saphenous vein in 18, the superficial femoral artery in five and a combination of different materials in three. RESULTS No deaths occurred during the first 30 days. Primary patency at 30 days was 90.8% following to six early thromboses. Three patients (5%) were lost to follow up. No other thrombosis occurred. At 8 years, the primary and primary-assisted patency were 88% and 91%, respectively. Survival was 95% at 9 years. Among the 53 hypertensive patients, two were lost to follow up. At 9 years, 22 (43%) were cured and nine (18%) were improved with a significant reduction of antihypertensive medication (p < .05). The pre-operative modification of the diet in renal disease (MDRD) clearance was 93 ± 29 mL/minute, the immediate post-operative MDRD was 94 ± 33 mL/minute, and at the end of follow up it was 86 ± 26 mL/minute (p > .05). CONCLUSION Ex vivo renal artery reconstruction for complex RABAs eliminates the risk of rupture, confers a benefit to hypertension, and preserves renal function with a satisfactory long-term patency.
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Hellmund A, Meyer C, Fingerhut D, Müller SC, Merz WM, Gembruch U. Rupture of renal artery aneurysm during late pregnancy: clinical features and diagnosis. Arch Gynecol Obstet 2015; 293:505-8. [DOI: 10.1007/s00404-015-3967-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
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Yadav S, Sharma S, Singh P, Nayak B. Pregnancy with a ruptured renal artery aneurysm: management concerns and endovascular management. BMJ Case Rep 2015; 2015:bcr-2015-211884. [PMID: 26504094 DOI: 10.1136/bcr-2015-211884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal artery aneurysm (RAA) affects <0.01% of the general population. Rupture of RAA is a rare catastrophe that can complicate pregnancy and is associated with high maternal and fetal mortality. Presentation is usually acute with severe flank pain, with or without haematuria, and haemodynamic instability requiring exploration and nephrectomy. A 26-year-old pregnant woman had sudden onset of gross haematuria and on evaluation was found to have a left RAA with an intrapelvic rupture and thinned out renal parenchyma. In view of the high risk of surgery, she was managed with endovascular placement of an Amplatzer type II vascular plug. Immediate and complete occlusion of blood flow was achieved and nephrectomy was avoided. Follow-up Doppler ultrasound revealed a reduced 5 cm mass in the left renal fossa with no internal flow and plug in position. She is currently on follow-up with 3-6 monthly ultrasonography not requiring any intervention.
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Affiliation(s)
- Siddharth Yadav
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Maughan E, Webster C, Konig T, Renfrew I. Endovascular management of renal artery aneurysm rupture in pregnancy - A case report. Int J Surg Case Rep 2015; 12:41-3. [PMID: 25996776 PMCID: PMC4486101 DOI: 10.1016/j.ijscr.2015.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/02/2015] [Accepted: 05/04/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Renal artery aneurysm rupture is an extremely rare cause of acute abdominal pain and haemodynamic instability in pregnancy. Due to its rarity, the diagnosis may not be immediately considered, and therefore there is a high associated mortality rate for both mother and fetus. PRESENTATION OF CASE We present a case of a 41-year old primigravida who presented to the obstetricians at 22 weeks' gestation with severe abdominal pain, shock and fetal loss. A bleeding renal artery aneurysm was discovered at laparotomy and radiologically coiled with sacrifice of the left kidney. Treatment of a contralateral aneurysm by autotransplantation of the remaining kidney allowed for preservation of residual renal function. DISCUSSION Surgical acute abdominal presentations can be difficult to interpret in pregnant patients. Pregnancy is known to be a contributing risk factor for spontaneous rupture of renal artery aneurysms, an otherwise rare mode of aneurysm presentation. Prompt use of imaging to diagnose and treat non-obstetric causes of the acute abdomen should not be delayed because of perceived risks to the fetus. Endovascular arrest of aneurysmal haemorrhage may be more effect in the context of a gravid uterus than surgical management. CONCLUSION In the shocked pregnant patient with an acute abdominal presentation, visceral artery aneurysm rupture may be comparatively more common, and should be considered in the absence of other localizing symptoms. Prompt interventional radiological treatment may be lifesaving in such cases.
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Affiliation(s)
- E Maughan
- Department of Surgery, Royal London Hospital, UK.
| | - C Webster
- Department of Surgery, Royal London Hospital, UK
| | - T Konig
- Department of Surgery, Royal London Hospital, UK
| | - I Renfrew
- Department of Interventional Radiology, Royal London Hospital, UK
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Wakimoto S, Hidaka N, Fukushima K, Kato K. Spontaneous post-partum rupture of an ovarian artery aneurysm: A case report of successful embolization and a review of the published work. J Obstet Gynaecol Res 2014; 41:456-9. [DOI: 10.1111/jog.12535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Shoko Wakimoto
- Department of Obstetrics and Gynecology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Nobuhiro Hidaka
- Department of Obstetrics and Gynecology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kotaro Fukushima
- Department of Obstetrics and Gynecology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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15
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Nakamura R, Koyama S, Maeda M, Kobayashi M, Tanaka Y, Kubota S, Isobe M, Shiki Y. Rupture of renal artery aneurysm during the early post-partum period. J Obstet Gynaecol Res 2013; 39:1476-9. [PMID: 23855369 DOI: 10.1111/jog.12083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/23/2013] [Indexed: 12/01/2022]
Abstract
Rupture of renal artery aneurysm associated with pregnancy is an uncommon condition. It is known that almost all previously reported cases have occurred during pregnancy. We experienced a case of rupture of renal artery aneurysm during the early post-partum period which was diagnosed by computed tomography and treated by angiographic embolization. To our knowledge, only two cases of rupture of renal artery aneurysm during the post-partum period have been reported in the English-language published work. An early diagnosis of rupture of renal artery aneurysm during the post-partum period is very challenging because the clinical symptoms of this condition are acute abdominal, flank or back pain, which are relatively common signs caused by more common post-partum complications. However, rupture of renal artery aneurysm is a life-threatening emergency condition requiring prompt diagnosis and treatment. The possibility of a rupture of renal artery aneurysm should be considered in any pregnant women with symptoms of an acute abdomen with hemorrhagic shock.
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Affiliation(s)
- Ryo Nakamura
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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16
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Endovascular treatment of renal aneurysms: A series of 18 cases. Eur J Radiol 2012; 81:3973-8. [DOI: 10.1016/j.ejrad.2012.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022]
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Treating coil migration in combination therapy involving stenting and coiling for a wide-necked renal aneurysm. Cardiovasc Interv Ther 2011; 26:286-9. [PMID: 24122599 DOI: 10.1007/s12928-011-0072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
Abstract
A man with a wide-necked renal artery aneurysm underwent combination therapy involving stenting and coiling to embolize it. However, a large section of one of the coils had migrated outside the stent implanted across the orifice of the aneurysm. After repositioning the migrated coil inside the stent, the implantation of another stent together with sandwiching of the coil between two stents repaired the prolapsed coil. This report describes precautions that should be taken during combination therapy involving stenting and coiling to embolize a wide-necked aneurysm.
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18
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Hwang PF, Rice DC, Patel SV, Mukherjee D. Successful management of renal artery aneurysm rupture after cesarean section. J Vasc Surg 2011; 54:519-21. [DOI: 10.1016/j.jvs.2010.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
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19
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Retroperitoneal haematomas in obstetrics: literature review. Arch Gynecol Obstet 2009; 281:435-41. [PMID: 19940999 DOI: 10.1007/s00404-009-1282-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is paucity of literature on retroperitoneal haemorrhage/haematomas (RH) as these cases are extremely rare in obstetrics. Experience is available mostly from case reports and therefore the incidence of RH in obstetrics is unknown. METHODS Literature search in Medline/Pubmed and Google scholar using MeSH; aneurysm, haematoma, haemorrhage, obstetrics and retroperitoneal. AETIOLOGY AND PATHOGENESIS This article discusses aetiology, pathogenesis, diagnostic difficulties and dilemmas, as well as misleading symptoms that often mimic common clinical conditions. DIAGNOSIS AND MANAGEMENT Management of RH is complex and continues to improve with advancements in the investigative strategies, treatment options and critical care specialty. Further the authors highlight the importance of basic principles of clinical examination, the need for multidisciplinary input and the current trend in the management options.
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20
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Hagihara M, Kitagawa A, Izumi Y, Ohshima Y, Katsuda E, Matsuda J, Kamei S, Kimura J, Kawamura T, Ishiguchi T. Emergent coil embolization for ruptured renal artery aneurysm. Jpn J Radiol 2009; 27:275-9. [DOI: 10.1007/s11604-009-0334-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
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21
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Leiva L, Arroyo A, Gesto R. Aneurisma sacular de arteria renal. Cir Esp 2009; 86:49-51. [DOI: 10.1016/j.ciresp.2009.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 01/15/2009] [Indexed: 10/20/2022]
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22
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Shibata SC, Mizobuchi A, Shibuta S, Mashimo T. Undiagnosed Thyrotoxicosis in a Pregnant Woman with Spontaneous Renal Artery Aneurysm Rupture. Anesth Analg 2009; 108:1886-8. [DOI: 10.1213/ane.0b013e3181a27cdf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Cianci R, Stivali G, Zaccaria A, Barbano B, Bianco P, Cerroni F. Renal artery aneurysm in a solitary kidney. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:500-3. [PMID: 17680595 DOI: 10.1002/jcu.20369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A 55-year-old hypertensive female was referred for renal artery color Doppler examination because of a suspicion of renovascular hypertension. Renal artery aneurysm was occasionally detected at the distal portion of the artery in the single left kidney, without the presence of stenosis. An aneurysm was confirmed via magnetic resonance angiography and arteriographical examination.
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Affiliation(s)
- Rosario Cianci
- Department of Clinical Medicine, Vascular Ultrasonographic Diagnostic Service, University of Rome, La Sapienza, Rome, Italy
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24
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Gallagher KA, Phelan MW, Stern T, Bartlett ST. Repair of complex renal artery aneurysms by laparoscopic nephrectomy with ex vivo repair and autotransplantation. J Vasc Surg 2008; 48:1408-13. [PMID: 18804939 DOI: 10.1016/j.jvs.2008.07.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Renal artery aneurysms are being discovered more frequently due to increased use of non-invasive imaging. Complex renal artery aneurysms involving multiple secondary or tertiary branches are not amenable to in vivo or endovascular treatment and often require ex vivo repair with autotransplantation. In order to minimize incisional morbidity and hasten recovery, we developed a technique of laparoscopic nephrectomy combined with backbench ex vivo repair, followed by autotransplantation through a small laparoscopic extraction incision. This study describes our initial experience with this combined technique in patients that were not candidates for endovascular techniques or in vivo arterial reconstruction. METHODS Seven patients with complex renal artery aneurysms underwent laparoscopic nephrectomy and ex vivo repair with multiple saphenous vein grafts and autotransplantation through the small laparoscopic extraction incision. The aneurysms ranged from 2.5 to 5.0 cm. In all cases, the aneurysm was resected ex vivo, leaving multiple branch arteries that were extended with saphenous vein grafts. Arterial inflow was then re-established with sequential saphenous vein anastomoses to the external iliac artery. Ureteral reconstruction was performed via standard Lich ureteroneocystostomy. Patients were followed postoperatively for two to eight years. RESULTS Laparoscopic nephrectomy with ex vivo repair of complex aneurysms was successfully employed in seven patients with renal aneurysms that were not amenable to endovascular or in vivo repair. There were no incisional morbidities and all patients had significant improvements in symptoms post-operatively. Renal function remained unchanged and there were no ureteral complications following surgery. All patients had postoperative ultrasound imaging done at two years which demonstrated patency of the anastomoses. The mean hospital stay was four days (range, two to seven days). CONCLUSION Repair of complex renal artery aneurysms involving distal branch arteries remains a challenge. This new technique combines the advantages of minimally invasive surgery with the effectiveness of ex vivo aneurysm repair.
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Affiliation(s)
- Katherine A Gallagher
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA
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25
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Paschalis-Purtak K, Januszewicz M, Puciłowska-Jankowska B, Szmidt J, Rowiński O, Prejbisz A, Szostek G, Michałowska I, Makowiecka-Cieśla M, Kabat M, Januszewicz A. Renal artery aneurysms: presentation of five cases. J Hum Hypertens 2007; 22:135-7. [PMID: 17728803 DOI: 10.1038/sj.jhh.1002274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We are presenting clinical characteristics, management and follow-up of five consecutive patients with renal artery aneurysm. Renal artery aneurysms are relatively uncommon, they rarely give rise to clinical manifestations and they are usually found incidentally. However with the introduction of Doppler ultrasound, computed tomography (CT) and magnetic resonance (MR) imaging, the diagnosis of renal artery aneurysms became more frequent.
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26
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Soliman KB, Shawky Y, Abbas MM, Ammary M, Shaaban A. Ruptured renal artery aneurysm during pregnancy, a clinical dilemma. BMC Urol 2006; 6:22. [PMID: 16945133 PMCID: PMC1569431 DOI: 10.1186/1471-2490-6-22] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 08/31/2006] [Indexed: 11/20/2022] Open
Abstract
Background Rupture of a renal artery aneurysm (RAA) during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. Case presentation We present here a case report of total avulsion of solitary kidney secondary to rupture of RAA in a pregnant patient with congenital absence of the contralateral kidney. The main indication for nephrectomy was severely damaged kidney. Diagnosis was made during operation and both mother and fetus were saved. There are no previous reports of an intact renal artery aneurysm diagnosed either antepartum or postpartum. Conclusion The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. This case was unusual because it occurred in a solitary kidney, during the third trimester of pregnancy.
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Affiliation(s)
- Khaled B Soliman
- Obstetrics Gynecology Department, Maternity and Children Hospital, Buraidah, Qassim, Saudi Arabia
| | - Yaser Shawky
- Obstetrics Gynecology Department, Maternity and Children Hospital, Buraidah, Qassim, Saudi Arabia
| | - Mohamed M Abbas
- Obstetrics Gynecology Department, Maternity and Children Hospital, Buraidah, Qassim, Saudi Arabia
| | - Mohamed Ammary
- General Surgery Department, King Fahd Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Allaa Shaaban
- Urology Department, King Fahd Specialist Hospital, Buraidah, Qassim, Saudi Arabia
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Knobloch K, Wiebe K, Lichtenberg A, Fischer S, Gohrbandt B, Haverich A. Ex vivo repair and renal autotransplantation for complex renal artery aneurysms in a solitary kidney. Ann Vasc Surg 2005; 19:407-10. [PMID: 15834683 DOI: 10.1007/s10016-005-0015-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Renal artery aneurysm (RAA) is a rare clinical entity with an incidence of 0.015-1%. Indications for interventional or surgical repair of RAAs are expanding aneurysms, diameter >2.5 cm, intractable renovascular hypertension, dissecting RAA, hematuria, and renal infarction after distal embolization. Interventional insertion of a stent graft as well as aortorenal bypass implantation are both low-risk procedures in simple aneurysms of the proximal renal artery. However, complex distal renal aneurysms involving several renal artery branches require not only an excellent result of vascular reconstruction, but also a surgical technique offering maximal protection for the kidney during the ischemic period. Here, we present a case of a solitary kidney with two consecutive RAAs of segmental renal artery branches (type 2 RAA). A surgical strategy including renal explantation, ex vivo renal preservation, ex vivo reconstruction of the renal artery, and renal heterotopic autotransplantation was successfully applied. The technique of ex vivo repair is a safe and effective surgical procedure in this clinical setting.
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Affiliation(s)
- Karsten Knobloch
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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28
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Rodríguez Corchero J, Martín Calero J, Martínez Rodríguez J, Huesa Martínez I, García Matilla F. [Renal artery calcified aneurysm in a female patient with solitary kidney, rare pathology]. Actas Urol Esp 2005; 28:672-6. [PMID: 16050202 DOI: 10.1016/s0210-4806(04)73159-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Renal artery aneurysm are uncommon. The true prevalence of renal aneurysms in the general population is unknown (less than 0.4%). Because of more widespread use of Angiography and CT as well as improved imaging techniques, they are diagnosed more frecuently. Fibromuscular dysplasia and arteriosclerotic occlusion of the renal artery are believed to be the most frecuent causes. In general, there are no pathognomonic signs and symptoms of renal aneurysm. Nonspecific complaints include flank pain, hematuria, hypertension and hypotension (suspect rupture of aneurysm). We report a case of a woman with a renal artery calcified aneurysm in a solitary kidney.
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Affiliation(s)
- J Rodríguez Corchero
- Servicio de Urología, Unidad de Litiasis, Hospital Universitario Virgen del Rocío, Sevilla
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Niizuma S, Nakahama H, Inenaga T, Yoshihara F, Nakamura S, Yoshii M, Kamide K, Horio T, Kawano Y. Asymptomatic renal infarction, due to fibromuscular dysplasia, in a young woman with 11 years of follow-up. Clin Exp Nephrol 2005; 9:170-3. [PMID: 15980954 DOI: 10.1007/s10157-005-0345-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 02/04/2005] [Indexed: 10/25/2022]
Abstract
We report a 27-year-old woman with renovascular hypertension, renal infarction, and hepatic artery aneurysm due to fibromuscular dysplasia. The patient was first noted to have renal artery aneurysm and hepatic artery aneurysm at the age of 17. The renal infarction was asymptomatic and was incidentally detected by magnetic resonance imaging (MRI) examination. Because of the rather peripheral location of the aneurysms, percutaneous transluminal renal artery angioplasty was considered inappropriate. This case suggests the need for long-term and periodical follow-up of patients with fibromuscular dysplasia.
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Affiliation(s)
- Shinichiro Niizuma
- Division of Hypertension and Nephrology, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
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30
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McDonnell C, Farrell N, Kelly I, Cross K. Endovascular Management of Renal Artery Aneurysm. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ejvsextra.2004.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Ghanavati F, Lavin A. Ruptured renal artery aneurysm in a pregnant woman with solitary kidney. J OBSTET GYNAECOL 2003; 23:564-6. [PMID: 12963524 DOI: 10.1080/0144361031000156555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F Ghanavati
- Ashington General Hospital, Department of Obstetrics and Gynaecology, Ashington, Northumberland, UK.
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Henke PK, Cardneau JD, Welling TH, Upchurch GR, Wakefield TW, Jacobs LA, Proctor SB, Greenfield LJ, Stanley JC. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg 2001; 234:454-62; discussion 462-3. [PMID: 11573039 PMCID: PMC1422069 DOI: 10.1097/00000658-200110000-00005] [Citation(s) in RCA: 249] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To define the relevance of treating renal artery aneurysms (RAAs) surgically. SUMMARY BACKGROUND DATA Most prior definitions of the clinical, pathologic, and management features of RAAs have evolved from anecdotal reports. Controversy surrounding this clinical entity continues. METHODS A retrospective review was undertaken of 168 patients (107 women, 61 men) with 252 RAAs encountered over 35 years at the University of Michigan Hospital. Aneurysms were solitary in 115 patients and multiple in 53 patients. Bilateral RAAs occurred in 32 patients. Associated diseases included hypertension (73%), renal artery fibrodysplasia (34%), systemic atherosclerosis (25%), and extrarenal aneurysms (6.5%). Most RAAs were saccular (79%) and noncalcified (63%). The main renal artery bifurcation was the most common site of aneurysms (60%). RAAs were often asymptomatic (55%), with a diagnosis made most often during arteriographic study for suspected renovascular hypertension (42%). RESULTS Surgery was performed in 121 patients (average RAA size 1.5 cm), including 14 patients undergoing unilateral repair with contralateral RAA observation. The remaining 47 patients (average RAA size 1.3 cm) were not treated surgically. Operations included aneurysmectomy and angioplastic renal artery closure or segmental renal artery reimplantation, aneurysmectomy and renal artery bypass, and planned nephrectomy for unreconstructable renal arteries or advanced parenchymal disease. Eight patients underwent unplanned nephrectomy, being considered a technical failure of surgical therapy. Dialysis-dependent renal failure occurred in one patient. There were no perioperative deaths. Late follow-up (average 91 months) was available in 145 patients (86%). All but two arterial reconstructions remained clinically patent. Secondary renal artery procedures included percutaneous angioplasty, branch embolization, graft thrombectomy, and repeat bypass for late aneurysmal change of a vein conduit. Among 40 patients with clearly documented preoperative and postoperative blood pressure measurements, 60% had a significant decline in blood pressure after surgery while taking fewer antihypertensive medications. Late RAA rupture did not occur in the nonoperative patients, but no lessening of this group's hypertension was noted. CONCLUSION Surgical therapy of RAAs in properly selected patients provides excellent long-term clinical outcomes and is often associated with decreased blood pressure.
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Affiliation(s)
- P K Henke
- Department of Surgery, Section of Vascular Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0329, USA.
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