Primary Renal Artery Dissecting Aneurysm: A Review

Abstract

Primary dissecting aneurysms of the renal artery are exceedingly rare. Our recent encounter with a patient with this condition prompted a review of the literature. The diagnostic and therapeutic problems in 30 patients were analyzed and guide lines for proper management were discussed. The triad of flank pain, hematuria and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition.

Primary Renal Artery Dissection

“…The characteristic elevation of BP was conspicuously absent in that the BP increase was either only labile (case 2) or modest and transient (case 1). Per sistently normal BP readings have been recorded in only 5 other IV patients [2, 32, 41, 45, 52], The contralateral recurrence of pain is also rare, being noted in only 3 other instances [7,35,55] before our case reports.…”

“…However, in some instances [52] (cases 1 and 2), a first normal IVP can arise because of an initial lack of consideration of the minor signs of renal ischemia or infarction, detected later by a second radiologist or by the time it takes the pyelographic signs to express them selves. As a matter of fact, ischemic abnormalities, or infarctus signs, can be found in a second IVP in 11 out of 12 cases interpreted before as being normal in the first IVP [20,22,23,27,32,34,35. 47] (case 1 ).…”

“…The revision of some artériographie documents [20,35,44] suggests that the diagnostic insufficiency of this procedure is mainly due to the lack of consideration of all the artériographie features.…”

Spontaneous renal artery dissection: three cases and clinical algorithms

“…[7][8][9] Therapeutic options used in the treatment of SRAD include watchful waiting, medical treatment of hypertension, endovascular techniques, in vivo or extracorporeal renal artery bypass or repair and partial or complete nephrectomy. 1,[9][10][11][12][13][14] SRAD represents a distinct pathologic entity, different from traumatic and iatrogenic RAD. 15 We present three cases of SRAD as well as a review of the literature.…”

Extracorporeal Repair of Primary Renal Artery Dissection

“…This false lumen compresses the true lumen and can occlude partially or totally the renal artery and its branches, causing renal ischemic lesions or infarctions. The classical clinical profile is costolumbar pain associated with a recent onset of hypertension and deterioration of renal function [3,4].Revascularization of the renal artery and its branches can be per formed by extracorporeal repair and microsurgical techniques using an autogenous vascular graft. This treatment allows preservation of renal function and cure of renovascular hypertension.…”