Management and Outcomes of Renal Artery Aneurysms in Older Adults

Renal artery aneurysms (RAAs) are rare but clinically significant vascular abnormalities. The management of RAA in older adults poses unique challenges related to their baseline comorbidities and age-related vascular changes. Traditionally, open surgery has been the gold standard for large or complex RAA. However, recent data and guidelines support a more conservative threshold for intervention and broader adoption of endovascular therapies, which offer lower perioperative morbidity, shorter hospital stays, and overall faster recovery. General indications for repair include symptomatic aneurysms, medically refractory hypertension, and lesions ≥3 cm. Medical management and surveillance are appropriate for asymptomatic patients with stable aneurysms < 3 cm, especially for those with limited life expectancy. Open surgical techniques include both in situ and ex vivo reconstructions with demonstrated long-term durability but are associated with higher perioperative risk. Endovascular techniques, including coil embolization and stent grafting, are increasingly being used in anatomically suitable patients with high success. Postoperative outcomes suggest comparable long-term results between open and endovascular approaches. However, endovascular repair is associated with fewer complications and is increasingly preferred in elderly or high-risk populations. An individualized approach is essential to optimize outcomes, balancing the risks of intervention with the natural history of the disease. This is a review of the epidemiology, diagnosis, management, and outcomes of RAAs in older adults.