Renal artery saccular aneurysm

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A 53-year-old woman was admitted for evaluation of a pulsating abdominal mass. She had visited the emergency department complaining of a racing heartbeat and headache, which had bothered her on and off for 4 years. She was normotensive. A workup for palpitation was negative; however, the physical examination found a pulsating abdominal mass in the right periumbilical area.

A computed tomography angiography (Cover) showed a 2.3 × 1.7-cm sized saccular aneurysm in the right renal artery, which was confirmed by renal angiography (A). Her elder sister had died of subarachnoid hemorrhage due to rupture of a cerebral artery aneurysm. Intracranial imaging was negative for cerebral aneurysm in this patient.

Under general anesthesia, a midline laparotomy incision was made, and an extended Kocher maneuver was used to expose the right renal hilum. After dissecting the saccular aneurysm on the right renal artery (B), surgical angioplasty was done by aneurysmorrhaphy, end-to-end anastomosis of the renal artery, and end-to-side anastomosis of the branch to the lower pole of the right kidney. Although the postoperative computed tomography angiography (C) showed a minor perfusion decrease and possibly a small upper pole infarction, the serum creatinine level was unchanged. The patient is doing well after full recovery.

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Comment 

Renal artery aneurysm is a relatively uncommon condition that is usually detected incidentally after an imaging workup.¹ In patients with concomitant hypertension, it has been reported that removal of the aneurysm results in improved control of blood pressure, although the mechanism is unclear.² Most patients with renal artery aneurysm are asymptomatic, but the risk of rupture is believed to increase when the diameter of the aneurysm is >1 to 2 cm. Therefore, it is recommended that aneurysms should be removed regardless of blood pressure status if it is >1.5 to 2 cm.² The treatment of choice is surgical aneurysmectomy and revascularization of the renal artery, although catheter-based endovascular interventions have been successfully performed on saccular aneurysms of the main renal artery with a small neck.³

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References 

1. Bulbul MA, Farrow GA. Renal artery aneurysms. Urology. 1992;40:1234-126
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2. Henke PK, Cardneau JD, Welling TH, Upchurch GR, Wakefield TW, Jacobs LA, et al. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg. 2001;234:454–463
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3. Soga Y, Sakai K, Nobuyoshi M. Renal artery aneurysm treatment with coil embolization. Catheter Cardiovasc Interv. 2007;69:697–700
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