Case Report
Percutaneous Stent-Graft Management of Renal Artery Aneurysms

https://doi.org/10.1016/S1051-0443(07)61362-1Get rights and content

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• Case 1

A 71-year-old woman with a 20- year history of hypertension presented with a complaint of low back pain radiating to the right flank for several months. She denied any hematuria and had no history of trauma or surgery. She was taking metoprolol and diazoxide. On admission, her blood pressure was 160/90 mm Hg. The remainder of her physical examination was unremarkable, and no subcostal bruits were auscultated. Her serum creatinine level was 0.9 mg/dL. Radiography of the lumbar spine did not show

DISCUSSION

Circumstances necessitating repair of RAA have been debated, with the current consensus including:

  • 1.

    RAA .2.0–2.5 cm in greatest diameter,

  • 2.

    RAA causing renovascular hypertension,

  • 3.

    dissecting RAA,

  • 4.

    RAA causing local symptoms (ie, flank pain, hematuria),

  • 5.

    RAA occurring in women of childbearing age with potential for pregnancy, as a result of an increased risk of rupture during pregnancy,

  • 6.

    RAA associated with functionally significant renal artery stenosis,

  • 7.

    RAA with distal embolization, and

  • 8.

    RAA with

CONCLUSION

Percutaneous techniques may be used as an alternative to surgery for the elective management of symptomatic or enlarging RAA. The angiographic pattern of the aneurysm and its feeding artery helps determine the optimal method of treatment. Stentgraft placement can be safely performed for the exclusion of saccular RAA arising from the main renal artery or proximal portion of large segmental arteries. Future devices are likely to reduce the technical difficulties associated with this procedure.

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    Citation Excerpt :

    Recently, less invasive interventional or endovascular techniques, such as coil embolisation or stent grafts, have successfully managed RAAs in selected patients.10,11 RAAs are classified into three categories, based on angiographic findings (Fig. 1): type I RAAs are saccular aneurysms originating from the main renal artery or proximally from a large segmental branch; type II RAAs are saccular or fusiform aneurysms of the branches of the main renal artery or proximal segmental branch; and type III RAAs are intralobar aneurysms of small segmental arteries or accessory arteries.12 Endovascular approaches via stents or coil embolisation are considered a suitable treatment option in patients with type I RAAs that are located up to 15 mm from the renal artery ostium or saccular aneurysms with a neck size < 4 mm in diameter.13

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