Renal artery aneurysm
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Renal artery aneurysms (RAA) are considered the second second most common visceral aneurysm (15-22%), most common being splenic artery aneurysm (60%). They are more more common in females. Most of the lesions are saccular and tend to occur at the bifurcation of main renal artery 1.
Epidemiology
RAAs occur in ~0.09% of the population 6.
Clinical presentation
Most cases are asymptomatic. Symptoms usually arise from rupture of aneurysm, embolisation of peripheral vascular bed or arterial thrombosis 1. Hypertension is associated in up to 73% cases of these aneurysm. Haematuria has also been reported in many cases.
Pathology
Aetiology 1-2
- fibromuscular dysplasia (34%)
- degenerative aneurysm (25%)
-
vasculitides (e.g. Behcet
diseasedisease) - phakomatoses (e.g. tuberous sclerosis, neurofibromatosis)
- intrinsic collagen deficiency (Marfan syndrome, Ehlers-Danlos syndrome)
- trauma
Radiographic features
CT
- noncontrast: soft tissue mass lesion in the region or course ofrenal artery
- postcontrast: contrast-filled outpouching
inin thecoursecourse of therenal artery
Angiography
Aneurysms can be well detected and characterized by angiography, in terms of size, neck diameter and type.
Treatment and prognosis
Management depends on various factors like age, sex, severity of hypertension, anticipated pregnancy, and aneurysm morphology. In any young female with anticipated pregnancy, embolization or endovascular intervention is suggested. Pregnancy-associated RAA rupture is associated with 80% mortality.
Follow-up for renal artery aneurysm 5:
- 1.0-1.5 cm: can be safely followed 6
- follow-up in 1-2 years, as long as patient is not premenopausal
- >1.5 cm
- consider surgical or endovascular repair
- surgical treatment is recommended for
aneurysmsaneurysms >2 cm in size
Modality of management depends on location:
- branch RAA: embolisation
- main renal artery RAA: ligation and bypass surgery, nephrectomy or stent placement
-<p><strong>Renal artery aneurysms (RAA)</strong> are considered the second most common visceral aneurysm (15-22%), most common being <a href="/articles/splenic-artery-aneurysm">splenic artery aneurysm</a> (60%). They are more common in females. Most of the lesions are saccular and tend to occur at the bifurcation of main renal artery<sup> 1</sup>.</p><h4>Epidemiology</h4><p>RAAs occur in ~0.09% of the population <sup>6</sup>.</p><h4>Clinical presentation</h4><p>Most cases are asymptomatic. Symptoms usually arise from rupture of aneurysm, embolisation of peripheral vascular bed or arterial thrombosis<sup> 1</sup>. Hypertension is associated in up to 73% cases of these aneurysm. Haematuria has also been reported in many cases.</p><h4>Pathology</h4><h5>Aetiology<sup> 1-2</sup>- +<p><strong>Renal artery aneurysms (RAA)</strong> are considered the second most common visceral aneurysm (15-22%), most common being <a href="/articles/splenic-artery-aneurysm">splenic artery aneurysm</a> (60%). They are more common in females. Most of the lesions are saccular and tend to occur at the bifurcation of main renal artery<sup> 1</sup>.</p><h4>Epidemiology</h4><p>RAAs occur in ~0.09% of the population <sup>6</sup>.</p><h4>Clinical presentation</h4><p>Most cases are asymptomatic. Symptoms usually arise from rupture of aneurysm, embolisation of peripheral vascular bed or arterial thrombosis<sup> 1</sup>. Hypertension is associated in up to 73% cases of these aneurysm. Haematuria has also been reported in many cases.</p><h4>Pathology</h4><h5>Aetiology<sup> 1-2</sup>
-<a href="/articles/vasculitis">vasculitides</a> (e.g. <a href="/articles/behcet-disease-2">Behcet disease</a>)</li>- +<a href="/articles/vasculitis">vasculitides</a> (e.g. <a href="/articles/behcet-disease-2">Behcet disease</a>)</li>
-<a href="/articles/phakomatoses">phakomatoses </a>(e.g. <a title="Tuberous sclerosis" href="/articles/tuberous-sclerosis">tuberous sclerosis</a>, <a title="Neurofibromatosis type 1 (NF1)" href="/articles/neurofibromatosis-type-1">neurofibromatosis</a>)</li>- +<a href="/articles/phakomatoses">phakomatoses </a>(e.g. <a href="/articles/tuberous-sclerosis">tuberous sclerosis</a>, <a href="/articles/neurofibromatosis-type-1">neurofibromatosis</a>)</li>
-<li>noncontrast: soft tissue mass lesion in the region or course of <a href="/articles/renal-artery">renal artery</a>- +<li>noncontrast: soft tissue mass lesion in the region or course of <a href="/articles/renal-artery">renal artery</a>
-<li>postcontrast: contrast-filled outpouching in the course of the <a href="/articles/renal-artery">renal artery</a>- +<li>postcontrast: contrast-filled outpouching in the course of the <a href="/articles/renal-artery">renal artery</a>
-</ul><h5>Angiography</h5><p>Aneurysms can be well detected and characterized by angiography, in terms of size, neck diameter and type.</p><h4>Treatment and prognosis</h4><p>Management depends on various factors like age, sex, severity of hypertension, anticipated pregnancy, and aneurysm morphology. In any young female with anticipated pregnancy, embolization or endovascular intervention is suggested. Pregnancy-associated RAA rupture is associated with 80% mortality.</p><p>Follow-up for renal artery aneurysm <sup>5</sup>: </p><ul>- +</ul><h5>Angiography</h5><p>Aneurysms can be well detected and characterized by angiography, in terms of size, neck diameter and type.</p><h4>Treatment and prognosis</h4><p>Management depends on various factors like age, sex, severity of hypertension, anticipated pregnancy, and aneurysm morphology. In any young female with anticipated pregnancy, embolization or endovascular intervention is suggested. Pregnancy-associated RAA rupture is associated with 80% mortality.</p><p>Follow-up for renal artery aneurysm <sup>5</sup>:</p><ul>
-<li>surgical treatment is recommended for aneurysms >2 cm in size</li>- +<li>surgical treatment is recommended for aneurysms >2 cm in size</li>
Images Changes:
Image 8 DSA (angiography) (Renal artery) ( create )
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