Renal Artery Aneurysms

Abstract

The various types of renal artery aneurysms are described, the most common one being the congenital saccular aneurysm. Usually asymptomatic it may be associated with hypertension and generally undergoes atherosclerotic degeneration. An arteriovenous fistula may form and rupture into the renal pelvis or retroperitoneal space in some rare instances. Small, well calcified saccular aneurysms should be left alone and followed; larger, incompletely calcified or non-calcified aneurysms should be removed. Fusiform aneurysmal dilatation of the renal artery occurs distal to a focal fibromuscular dysplastic stenosis. This type is almost invariably found in hypertensive young people. Thrombosis of a branch may occur distal to the aneurysm. These aneurysms should be treated surgically, usually by excision of the stenotic area and its aneurysm, and anastomosis of branches back to the main renal artery. Dissecting aneurysms of the renal artery are the most damaging to the kidney. Complications are thrombosis of the branches, infarction of the kidney and a virulent form of hypertension. An operation should be done to correct the dissection and to remove part or all of the kidney when infarction is severe. Intrarenal arterial aneurysms are prone to hemorrhage and should be removed by local excision or partial nephrectomy.

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…The other causes of renovascular disease are myriad (663-673) and include Takayasu's arteritis (671-673), atheroemboli, thromboemboli, William's syndrome (669,671), neurofibromatosis (670,671), spontaneous renal artery dissection, arteriovenous malformations or fistulas, trauma (e.g., lithotripsy, direct injury, or surgery), and prior abdominal radiation therapy (665)(666)(667)(668). Rarely, retroperitoneal fibrosis producing external compression has also been associated with RAS.…”

Primary Renal Artery Dissection

“…The low capability of isotopic renoscintigraphy to un cover renal infarction (never mentioned) or to locate renal ischemia correctly (27.8%) in 1 series of 18 renoscin tigraphies [45] was not verified by the present case re ports and by the 5 out of 6 other cases in which this type of investigation was followed [30,31,36,51,54,55].…”

“…Three days after the arteriography, the patient experienced right lumbar pain which vanished the next day, but right lumbar tenderness to percus sion persisted for another 5 days. Repeated isotopic renoscintigra-Béroniadc/Rov/Fromcnt/Pison phy (July 30,1984) confirmed an infarction of the middle third of the right kidney. BP increased slightly 8 days after the first colic pain and was controlled with 2.5 mg Pindolol b.i.d.…”

“…Of significance are: (1) the coexistence of dissection signs on other abdomi nal arteries [20,23,30,41,50]; (2) coexisting abnormal ities on patent branches in cases of occlusion [34]; (3) the tendency of dissection to start in the main renal arteries and to stretch distally' in the division branches, with less proximal extension, and (4) the reversibility of artério graphie changes, observed in 7 [20. 26, 53, 54, 56] out of 14 arteriographies repeated for follow-up purposes only.…”

“…The most significant and controversial etiological argument is the causal rela tionship between FMD and PRAD. The problem is com pounded by the fact that the same case may [30,32,47] or may not [20. 26, 27.…”