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  • • Uncommon

    • Usually saccular located at primary or secondary bifurcation

    • 4 categories:

    • 1. True aneurysm

      2. Dissecting aneurysm

      3. Aneurysms associated with fibrodysplastic disease

      4. Arteritis-related microaneurysms

    • Renovascular hypertension can be due to:

    • -Associated arterial stenosis

      -Dissection

      -AV fistula

      -Thromboembolism

      -Compression of adjacent arterial branches

    • Rupture is rare except during pregnancy, results in loss of kidney; death is rare

    • Emboli from aneurysm to distal vessels occur rarely

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Epidemiology

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  • • < 0.1% of population

    • Associated with hypertension

    • Occurs slightly more often in women than in men

    • Rupture rate, 3%

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Symptoms and Signs

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  • • Most asymptomatic

    • Discovered incidentally or during work-up for hypertension

    • 30% of patients present with renovascular hypertension

    • Rupture (during pregnancy)

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  • • Must consider arteritis

    • Evaluation of other sites of aneurysm formation (visceral and peripheral)

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  • • Angiography or magnetic resonance imaging for definition

    • CT scan can be useful for follow-up

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  • • Small renal aneurysms managed conservatively with CT scans, angiography every 2 years

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Surgery

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  • • Repair when indicated: repair in situ, ligate and bypass

    • Nephrectomy if ruptured

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Indications

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  • • Women of childbearing age

    • Patients with associated renal artery disease

    • Large aneurysms (increased rate of rupture with larger aneurysms not proven)

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References

Chuter TA. Fenestrated and branched stent-grafts for thoracoabdominal, pararenal and juxtarenal aortic aneurysm repair. Seminars in Vascular Surgery 2007. 20(2):90-6.  [PubMed: 17580246]
Eskandari MK. Resnick SA. Aneurysms of the renal artery. Seminars in Vascular Surgery 2005. 18(4):202-8.  [PubMed: 16360577]

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