Intraparenchymal renal artery aneurysms. Case report with review and update of the literature

Abstract

Increased interest in aneurysms involving the renal artery and its branches has occurred during the past 3 decades. The prevalence of renal artery aneurysms is approximately 0.01%-1% in the general population as well as 2.5% in hypertensive patients undergoing angiography. Intraparenchymal renal artery aneurysms (IPRAAs) are rare since being detected in less than 10% of patients with renal artery aneurysms. The Authors report an unusual case of multiple small intrarenal artery aneurysms associated with a large IPRAA located in the mid portion of the right kidney. Usually, IPRAAs are secondary to diseases or injuries of the kidney vascular network. They are classified as true, false, saccular, fusiform, dissecting, and microaneurysms. Potential complications of IPRAAs include peripheral dissection, thrombosis, hypertension, renal infarction and rupture. IRAAs may be detected incidentally as well as present with urologic symptoms and signs related to complications. Actually, IRAAs are investigated by non invasive modalities including duplex ultrasound, magnetic resonance angiography, spiral three-dimensional computed tomography angiography, and three-dimensional reconstructed rotational digital substraction angiography of the segmental and distant branches of the renal artery. Angiography with intrarterial injection of contrast material is the gold standard in diagnosing IPRAAs. Treatment options for IPRAAs include observation, aneurysmectomy with surgical repair, endovascular procedures, nephrectomy or partial nephrectomy. Observation is indicated for asymptomatic intraparenchymal renal artery aneurysms measuring less than 2 cm in diameter. Surgical repair of IPRAAs includes aneurysmectomy and reconstruction of the renal artery by in vivo or ex vivo technique. The procedure is indicated for IPRAAs causing renovascular hypertension, dissection, urologic symptoms, embolization, local expansion and women of childbearing age with a potential for pregnancy. In recent years, transcatheter arterial embolization has emerged as a simple, useful and effective technique in managing IRAAs. The procedure is performed by transfemoral catheterization as well as by superselective catheterization and embolization of interlobar arteries with 3F microcatheters. Endovascular occlusion is obtained by using gelatin sponge, steel coils, detachable baloons, and conventional non-detachable microcoils delivered through a microcatheter. Nephrectomy or partial nephrectomy are reserved for conditions precluding renal revascularization which include overt RAA rupture, covert RAA rupture, artery-to-vein fistula, renal cell carcinoma, end stage nephropaty, renal infarction, severe ischemic renal atrophy or complex intrarenal aneurysms. Recently, partial nephrectomy by the laparoscopic approach has been proposed for managing IPRAAs and the procedure is considered feasible and safe.

Pregnancy and Delivery in Women with Renovascular Hypertension due to Multiple Intrarenal Microaneurysms: A Report of Two Cases

“…Renal artery aneurysms are found in 0.1% of the general population, and in 2.5% of hypertensive patients undergoing angiography (2,8). Aneurysms are seen more frequently in women than in men.…”

“…It is known that collagen tissue diseases, such as polyarteritis nodosa and systemic lupus erythematosus, are involved in the pathogenesis of multiple intrarenal microaneurysms (1)(2)(3). Aneurysms are found most frequently in women of childbearing age, and often cause renovascular hypertension.…”

Hematuria como forma de presentación de un aneurisma intrarenal

“…Hasta la actualidad, y bajo nuestro conocimiento, no hemos encontrado descritas los aneurimas de arterias distales. Generalmente, las alteraciones vasculares, está n acompañ adas de clínica de hipertensió n arterial [1][2][3][4] . En el caso que nos ocupa el ú nico síntoma fue la hematuria macroscó pica y el dolor lumbar de 48 h de evolució n, probablemente la evolució n fue mucho mayor, pues el paciente no relata que 15 añ os antes le diagnosticaron de calcificació n renal derecha.…”

Emergent coil embolization for ruptured renal artery aneurysm

“…1 Patients with RAA are often asymptomatic, but it can be lifethreatening when rupture (although rare) occurs. [2][3][4] We report a case of ruptured renal artery aneurysm successfully treated by emergent transcatheter embolization with microcoils.…”