Renal artery aneurysm

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Renal artery aneurysm

  1. 1. Samir Haffar M.D. Renal artery aneurysm Case report
  2. 2. A 23 Years old man was admitted to the emergency department because of severe abdominal pain located in the right upper quadrant & beginning 4 hours earlier.
  3. 3. Routine lab exam showed the presence of plenty of erythrocytes in the urine. The initial diagnosis was a stone in the right ureter.
  4. 4. Abdominal ultrasound performed in the evenings 1 hour after admission, showed the presence of cystic mass measuring 8 cm located in the right renal pelvis with dilatation of the calyceal cavities around this mass.
  5. 5. Ultrasound of the right kidney – 1 Large cystic mass in the right upper quadrant
  6. 6. Cystic mass of 8 cm located in the right renal pelvis Ultrasound of the right kidney – 2
  7. 7. Ultrasound of the right kidney – 3 Large cystic mass in right renal pelvis Dilatation of calyceal cavities around the mass
  8. 8. Color Doppler US of the cystic mass Swirling multidirectional flow inside the cystic mass
  9. 9. Pulsed Doppler US of the cystic mass Forward and backward flow inside the cystic mass
  10. 10. Communication of cystic mass with RRA Color Doppler USBlack & white US Communication of right renal artery with the cystic mass
  11. 11. Jet of RRA inside the cystic mass
  12. 12. The study of the right renal artery with color Doppler US clearly showed the communication of this cystic mass with the right renal artery and the jet inside it.
  13. 13. The diagnosis of right renal artery aneurysm with threaten rupture was made. The urologist was informed by telephone & renal arteriogram was planned for the next day.
  14. 14. At 5.00 AM the next day, the patient was in choc. An urgent laparotomy was done. The diagnostic was confirmed at operation. The surgeon was obliged to performed a right nephrectomy
  15. 15. Renal artery aneurysm Age Most are found in pts 50 - 70 years of age. Causes Atherosclerosis & fibromuscular disease. Number 30 % multiple aneurysms in the same side 20% of aneurysms are bilateral Symptoms Most discovered incidentally Few pts have symptoms due to aneurysm Hypertension is the most common symptom Zubarev AV. Eur Radiol 2001 ; 11 : 1902 – 1915.
  16. 16. Location Along the course of the main RA Color Doppler Effective non-invasive means of dg. Outpoushing containing color flow Complications Rupture Thrombosis Dissection Embolization Renal artery aneurysm
  17. 17. Treatment of RAA Indications Clinical symptoms: back pain – hematuria – HTN Renal dysfunction: peripheral thromboembolism Size of aneurysm Pregnancy Methods Surgical resection Percutaneous interventions Arterial embolization Expandable stent-graft for fusiform aneurysms Adopted more frequently Less invasive Lower cost Follow-up evaluation Shonai T et al. J Ultrasound Med 2000 ; 19 : 277 – 280.
  18. 18. Treatment of ruptured RAA Surgery Midline approach Supraceliac aortic control (juxtarenal hematoma) If proximal control of RA obtained: supraceliac clamp removed Salvaging of kidney Bleeding controlled Patient hemodynamically stable Quick bypass of proximal & distal RA Nephrectomy Required most often Patient instable Prolonged ischemia of kidney Aneurysm extends into renal parenchyma Rutherford RB – Vascular Surgery – Fifth edition – WB Saunders 2000

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