Renal autotransplantation to treat renal artery aneurysm: case report

Abstract

CONTEXT: Renal artery aneurysm (RAA) is uncommon and usually asymptomatic, but complications like rupture or thromboembolism of the aneurysm can occur, with consequent renal infarction. Most of the clinical findings are found incidentally through imaging examinations, in investigating other diseases. Renal autotransplantation (RAT) is an alternative treatment for complex RAA, with satisfactory results described in the literature. CASE REPORT: The patient was a 48-year-old man with a history of systemic arterial hypertension, thrombocytopenia and advanced hepatosplenic schistosomiasis. He complained of right lumbar pain, which was investigated through imaging examinations (computed tomography and angiotomography). These revealed right RAA of 2.5 cm in diameter. Evaluation by the vascular surgery team found that this was untreatable using endovascular methods. The treatment performed was open right nephrectomy with kidney preservation in solution, followed by aneurysmectomy, suturing of the injured artery and kidney reimplantation in the right iliac fossa with anastomosis of the iliac vessels and ureter. The durations of the surgery and kidney ischemia were 385 and 140 minutes, respectively. The patient was discharged on the 20 th postoperative day, with creatinine concentration of 1.4 mg/dL, urea 41 mg/dL, urine volume 1400 mL/24 h and ascites treated with diuretics. CONCLUSION: RAT is indicated basically in three situations: extracorporeal reconstruction of complex aneurysms of the renal pedicle, extensive ureteral injury, and conservative kidney cancer surgery in patients with a single kidney. This study presents a case of a patient with advanced liver disease and RAA that was untreatable using endovascular methods and was successfully treated using RAT. RESUMOCONTEXTO: O aneurisma de artéria renal (AAR) é incomum e, em geral, assintomático, mas podem ocorrer complicações como rotura ou embolia de trombos do aneurisma com consequente infarto renal. A maioria dos achados clínicos é encontrada acidentalmente por exames de imagem na investigação de outras doenças. O autotransplante renal (ATR) constitui-se em alternativa de tratamento de AAR com resultados satisfatórios descritos na literatura. RELATO DE CASO: Paciente masculino, 48 anos, com histórico de hipertensão arterial sistêmica, plaquetopenia e esquistossomose hepatoesplênica avançada. Referia dor lombar direita que após exames de imagem (tomografia computadorizada e angiotomografia) revelou AAR direita com 2,5 cm de diâmetro não tratável por via endovascular após avaliação da equipe de cirurgia vascular. O tratamento realizado foi uma nefrectomia aberta direita com preservação renal em solução, seguida de aneurismectomia, sutura da artéria lesada e reimplante do rim na fossa ilíaca direita com anastomoses dos vasos ilíacos e do ureter. O tempo cirúrgico e de isquemia renal foram de 385 e 140 minutos, respectivamente. Recebeu alta hospitalar no vigésimo dia do pós-operatório, com concentrações de creatinina de 1,4 mg/dL, ureia de 41 mg/dL, volume u...

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms

“…Endovascular techniques like stent graft placement or coil embolization are reserved for more proximal aneurysms with a narrow neck. 7 , 8 …”

Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso

“…Como se había mencionado previamente, en lo que respecta a los aneurismas de la arteria renal ubicados en las ramificaciones de la arteria renal, el tratamiento suele ser quirúrgico 8,20 . Hasta el momento, una de las series más grandes incluyó 67 pacientes y fue publicada por Duprey, et al, en el 2016, quienes concluyeron que, a pesar de la baja frecuencia de esta enfermedad, de que la 'evidencia' no es exactamente fuerte por la misma razón y con base en los resultados obtenidos, concluyeron que el autotrasplante renal es una opción segura para el tratamiento de aneurismas de la arteria renal.…”

Blood Flukes and Arterial Damage: A Review of Aneurysm Cases in Patients with Schistosomiasis

“…Aneurysm occurred also in patients with known chronic schistosomiasis [ 12 ], in an advanced stage with clinically manifest complications, such as oesophageal varices [ 14 ], hepato-splenic schistosomiasis [ 16 , 24 , 25 ], in one case waiting for liver transplant [ 16 ] and in pulmonary schistosomiasis [ 12 ].…”

“…Aneurysmectomy and direct suture have been used to treat an aortic arch pseudoaneurysm by D. A. Athanazio and P. R. F. Athanazio [ 23 ]. Nephrectomy, aneurysmectomy, and renal reimplantation have been successfully described in a renal artery aneurysm [ 25 ]. Splenectomy has been considered in a portal branch aneurysm associated with portal hypertension.…”

“…In these cases, the diagnosis of Schistosoma infection was reached by serological investigations [22], stool sample assessment, rectal biopsy [19], and histology of lung [17] or of liver and testis [23]. Aneurysm occurred also in patients with known chronic schistosomiasis [12], in an advanced stage with clinically manifest complications, such as oesophageal varices [14], hepato-splenic schistosomiasis [16,24,25], in one case waiting for liver transplant [16] and in pulmonary schistosomiasis [12].…”