Rupture of a Saccular Renal Artery Aneurysm: Report of a Case

Bonamigo, Telmo Pedro; Erling, Nilon; Faccini, Felipe Puricelli

doi:10.1007/s005950200143

Cited by 18 publications

(10 citation statements)

References 12 publications

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“…IRAAs may be detected incidentally as well as present with urologic symptoms and signs related to complications [2,3,7,30,31]. Flank or abdominal pain may be secondary to IRAA rupture with retroperitoneal hemorrhage as well as renal infarction.…”

Section: Discussionmentioning

confidence: 95%

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

Porcaro¹,

Migliorini²,

Pianon³

et al. 2004

Int Urol Nephrol

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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.

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Section: Discussionmentioning

confidence: 95%

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

Porcaro¹,

Migliorini²,

Pianon³

et al. 2004

Int Urol Nephrol

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“…Rarely, it may be caused by rupture of renal or mesenteric aneurysms (4–8) or ovarian artery aneurysms (9). Bleeding can occur from underlying causes in any of the retroperitoneal structures, such as the pancreas (10), adrenal glands (11) or kidneys (5). It may also occur as a complication of any retroperitoneal surgery, which may be open or laparoscopic (12).…”

Section: Introductionmentioning

confidence: 99%

Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery?

Chan

Morales

Reidy

et al. 2007

International Journal of Clinical Practice

203

222

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“…However, there is a high possibility of a spontaneous rupture of the aneurysm, resulting in a life-threatening course. 3 Therefore, such aneurysms should be treated promptly. In the present case, the patient had a maximum aneurysm diameter of 27 mm, which constituted a particular therapeutic target.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Ogawa¹,

Yanagida²,

Kataoka³

et al. 2012

Exp Clin Transplant

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We describe in this report the case of a renal aneurysm in a 42-year-old woman. The aneurysm measured 27 mm in diameter, and was sited at the first bifurcation of the renal artery. We performed laparoscopic nephrectomy, ex vivo angioplasty and renal autotransplant to avoid ischemic damage to the kidney during reconstruction. The patient recovered and was discharged from the hospital without any complications. Hence, we suggest these treatments can be effectively done in patients with complex renal aneurysms. Key words: Renal artery aneurysm, Laparoscopic nephrectomy, Extracorporeal reconstruction, Renal autotransplantation, Renal functionSince renal autotransplant was first described by Hardy in 1963, 1 it has been used to treat patients with renovascular diseases, ureter injuries, and renal tumors. We present the case report of a patient with a renal artery aneurysm who underwent nephrectomy, ex vivo angioplasty of the renal artery, and renal autotransplant who recovered without complications. Case ReportA 42-year-old woman visited the district general hospital, complaining of a history of continuous fever and fatigue. Her urine was clear; however, results of screening abdominal ultrasonography revealed a hypoechoic mass in the upper part of the right kidney. Doctors there suspected a right renal artery aneurysm and referred her to our hospital. On admission, her blood pressure was normal, and serum creatinine and blood urea nitrogen concentrations were within normal ranges. Results of 3-dimensional computed tomography (CT) and selective renal angiography showed a saccular right renal artery aneurysm measuring 27 mm in diameter (Figures 1 and 2). From these images, we also ascertained that the aneurysm originated from the first bifurcation of the renal artery. Results of a subsequent renogram showed normal split renal function of the bilateral kidney. The CT and angiography results indicated that endovascular coil embolization was impossible, owing to the morphology and site of the aneurysm. Based on these findings, the patient was scheduled for laparoscopic nephrectomy, ex vivo repair, and autotransplant.The patient was placed in the lateral decubitus position with the left side down. Three 12-mm ports and a 5-mm port were inserted into the retroperitoneal space. After dissection of the renal hilum, the right renal artery and the aneurysm were

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Rupture of a Saccular Renal Artery Aneurysm: Report of a Case

Cited by 18 publications

References 12 publications

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

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

Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery?

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

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