Techniques and Strategies for the Endovascular Treatment of Renal Artery Aneurysm

Barros, Keillyanne Jaira Ferreira; Metzger, Patrick Bastos; Rossi, Fábio Henrique; Rodrigues, Thiago Osawa; Moreira, Samuel Martins; Petisco, Ana Cláudia Gomes Pereira; Izukawa, Nilo Mitsuru; Kambara, Antônio Massamitsu

doi:10.1016/s2214-1235(15)30181-2

Cited by 5 publications

(11 citation statements)

References 21 publications

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“…Microcatheters are used to deliver liquid embolic agents such as Onyx ® (ethylene vinyl alcohol copolymer dissolved in DMSO) (Micro Therapeutics, Inc., Irvine, CA), and N-butyl cyanoacrylate-Hystoacril ® (B. Braun Surgical S.A. [Melsungen, Germany] in Spain). [13] To improve the radio-opacity, these agents can be mixed with Lipiodol ® or Micronized tantalum powder.…”

Section: Discussionmentioning

confidence: 99%

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Renal artery aneurysm induced by neurofibromatosis type 1: A case report and review of the endovascular interventions for this rare vasculopathy

Alsheikh

2023

Medicine

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Rationale: The autosomal dominant condition known as neurofibromatosis type 1 (NF-1) is characterized by café au lait macules and neurofibromatosis. Aneurysms in renal arteries are rare. Renal artery aneurysm (RAA) can be successfully treated with endovascular procedures; however, successful cases in NF-1 adults have not been reported. Patient concerns: Here, we report the case of a 30-year-old female suffering from NF-1. The patient presented to the emergency department with complaints of chronic, poorly controlled hypertension. A left RAA was found om the computed tomography angiography (CTA). Diagnoses: A left renal artery aneurysm was diagnosed using CTA during workup for secondary hypertension. Interventions: Selective angiographym of the left renal artery confirmed a fusiform aneurysm of the distal renal artery. A self-expandable covered stent was placed, and a completion angiogram demonstrated good aneurysm sealing and contrast flow to the left kidney. Outcomes: The patient’s blood pressure improved after the procedure. Her medications were lowered to almost half of their baseline doses, and hydralazine was discontinued. On the follow-up visit after 4 months, the patient reported his home-measured systolic blood pressure to be less than 120 mm Hg. A repeated CTA of the abdomen showed post-left RAA repair with a covered stent and interval improvement of the left kidney. Lessons: RAA caused by NF-1 are manageable and feasible with endovascular intervention.

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Section: Discussionmentioning

confidence: 99%

“…This is the most often recommended approach for treating saccular aneurysms with a neck size less than 4 mm in diameter or an aneurysm-to-neck ratio >2:1. [13] This approach can be used to treat all 3 types of RAA. This option is not recommended to be used in aneurysms of wide-neck and complex aneurysms with efferent branches.…”

Section: Discussionmentioning

confidence: 99%

Renal artery aneurysm induced by neurofibromatosis type 1: A case report and review of the endovascular interventions for this rare vasculopathy

Alsheikh

2023

Medicine

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“…Currently, there are no FSI study focusing on a wide-neck, saccular renal artery aneurysm (RAA) at the main renal artery. Most of the studies regarding renal artery aneurysm (RAA) are in the likes of retrospective studies (Barros et al 2014;Gates et al 2017;Wang et al 2018) or case studies (Canyiğit M et al 2015;Chandra et al 2014;Hwang et al 2011;Maughan et al 2015;Sousa et al 2017;Sultan et al 2016). The FSI study is important to understand the mechanism of rupture of aneurysm at renal artery especially in the case of wide-neck aneurysm (Canchi et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Stent Porosity Efficiency in Treating Wide-Neck Saccular Renal Artery Aneurysm

Bakar¹,

Abas²,

Razak³

2020

JAFM

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Renal arteries are the arteries that supply blood to the kidneys. Renal arteries are the arteries that supply blood to the kidneys. Renal artery aneurysm (RAA) is the second most common visceral aneurysm to occur, which accounts for 22% of the visceral aneurysm. In general population, RAA rate of occurrence was only 0.1%. However, due to the extensive used of angiography technique, RAA has been discovered more frequently. Some claimed that the previous rate of incidence should be higher now because of the capability of angiography. The rupture of this aneurysm could result in haemorrhage, kidney lost and mortality. The size of the renal artery which is different compared to other types of arteries such as the abdominal aorta could produce different flow condition when the artery is inflicted with RAA condition. Thus, a thorough analysis is desired as RAA studies are very limited compared to other aneurysm conditions. In this study, the efficiency of the stent porosity was investigated in treating the RAA. Fluid-structure interaction (FSI) simulations and particle image velocimetry (PIV) experiments were the approaches taken to investigate the flow patterns of the blood when the stent of different porosities was placed in the aneurysm entrance. The effect of wall shear stress (WSS), the deformation of the artery and von Mises stress were also observed in determining the possibility of aneurysm rupture. The study found that the placement of stent of different porosities succeeds in providing an obstruction to the blood from circulating inside the aneurysm sac. This in turns reduced the WSS experienced by the aneurysm sac up a significant value of 96%. This reduction is crucial in order to prevent the aneurysm from rupture. Moreover, the placement of the stent provided support to the renal artery and preventing it from experiencing buckling failure. The maximum deformation of the artery reduced by 42% with stent was placed in the renal artery. In fact, the von Mises stress decreased below the threshold limit of 0.5 MPa with the presence of the stent. In addition, the study found that the stent of porosity 80% has a similar impact to the stent of lower porosity in the case of RAA at main renal artery.

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“…This preliminary assumption is based on the autopsy results, and with the recent technology in the angiography, the true incidence is expected to be higher (Hwang et al 2011). The natural history of RAA is barely known and its symptoms are nonexistent (Barros et al, 2014). Fibrodysplasia, congenital disorder, trauma and inflammatory causes are a few suggested etiology of the RAA (Malacrida et al 2007).…”

Section: Introductionmentioning

confidence: 99%

“…The treatment for RAA can be of two types; a conventional surgery and an endovascular procedure. The advancement of the latter has reduces the morbidity and mortality rate, with the advantage of preserving the native vascular tree (Barros et al, 2014). Endovascular (EVAR) is a novel minimally invasive technique performed as an alternative to conservative surgical method and it is included in the management options for the elective repair of the arterial aneurysm (Mokhtar et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Stent in the Treatment of Renal Artery Aneurysm using FSI Simulation

Bakar¹,

Abas²,

Razak³

2019

JAFM

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Renal artery aneurysm (RAA) is a condition that affects approximately 0.1% of the general population. The rate of incidence is minimal compared to other type of aneurysm but a high number of ruptures have been reported in pregnancy, especially at the third trimester. The concerning issue is that the maternal mortality rate stretches up to 50% and the fetal mortality rate approaching 85% with a universal loss of the affected kidney. This study aimed at investigating the effectiveness of stent in treatment of RAA using the fluid-structure interaction (FSI) approach. The flow pattern, wall shear stress (WSS), deformation and von Mises stress experienced are compared between RAA model without stent and with Abbott RX Herculink stent. A simple PIV experiment, observing the flow profile was conducted as a validation steps in ensuring the simulation results are reliable and accurate. The findings show that the simulation and PIV data are in good agreement in terms of the flow profile. The presence of stent managed to reduce the blood flow maximum velocity down to 46% and minimized the circulation of blood in the aneurysm dome. As for the WSS, the used of stent succeeded in decreasing the WSS experienced by the wall of aneurysm by 71% and below the baseline level of WSS that could induced rupture. The deformation of RAA and maximum von Mises stress reduced by 58% and 73% respectively when stent is used. In addition, the maximum von Mises stress after the stent placement is lower than the threshold value for the ultimate tensile strength of the tissue. This study concluded that the stent placement is effective in reducing the risk of aneurysm rupture in renal artery it can be one of the baseline for the further study regarding the RAA.

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Techniques and Strategies for the Endovascular Treatment of Renal Artery Aneurysm

Cited by 5 publications

References 21 publications

Renal artery aneurysm induced by neurofibromatosis type 1: A case report and review of the endovascular interventions for this rare vasculopathy

Renal artery aneurysm induced by neurofibromatosis type 1: A case report and review of the endovascular interventions for this rare vasculopathy

Stent Porosity Efficiency in Treating Wide-Neck Saccular Renal Artery Aneurysm

Effectiveness of Stent in the Treatment of Renal Artery Aneurysm using FSI Simulation

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