Ex vivo repair of renal artery aneurysms

Renal artery aneurysms (RAAs) are rare but remain challenging lesions when treatment is required. Endovascular techniques may be useful in selected, more proximal lesions with amenable morphology, but open surgical repair is often required for more distal, anatomically complex hilar RAAs that often have several branches and unfavorable anatomy. This study reviewed a single-center experience with ex vivo repair of 14 of these more complex, distal RAAs.

The records of 14 consecutive patients having ex vivo RAA repair between 1997 and 2013 were retrospectively reviewed. Demographic data, operative details, and blood pressure and renal function status were recorded. Graft patency was observed with renal duplex sonography.

Fourteen hilar RAAs were repaired in 10 women and 4 men with a mean age of 54 years. Hypertension was present in 12 (86%). Preoperative renal dysfunction was present in two (14%). Aneurysm size averaged 2.9 cm. Six RAAs (43%) were symptomatic with flank or abdominal pain. Ex vivo repair was performed in all cases with use of saphenous vein for renal-renal bypass. No patient had pelvic autotransplantation or concomitant aortic reconstruction. Ex vivo RAA repair was technically successful in 12 cases; two patients required nephrectomy. Two patients with pre-existing renal insufficiency had improvement postoperatively, but hypertension was clinically unchanged in all patients. No patient required postoperative dialysis. Duplex sonography documented continued graft patency in the 12 technically successful cases during a mean follow-up of 19 months.

Open ex vivo surgical repair with renal-renal bypass is a successful and durable treatment for complex distal RAAs that require repair. These procedures had low morbidity and mortality and an acceptable rate of renal function preservation. Blood pressure control in these patients did not change significantly after RAA repair.