Renal Artery Aneurysms

• • 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

Epidemiology

• • < 0.1% of population

  • Associated with hypertension

  • Occurs slightly more often in women than in men

  • Rupture rate, 3%

Symptoms and Signs

• • Most asymptomatic

  • Discovered incidentally or during work-up for hypertension

  • 30% of patients present with renovascular hypertension

  • Rupture (during pregnancy)

• • Must consider arteritis

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

• • Angiography or magnetic resonance imaging for definition

  • CT scan can be useful for follow-up

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

Surgery

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

  • Nephrectomy if ruptured

Indications

• • Women of childbearing age

  • Patients with associated renal artery disease

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

References