Renal artery aneurysms (RAAs) are rare but can be life-threatening if ruptured. Endovascular options for treating RAAs include coil embolization, covered stent grafts, liquid embolization, stent-assisted coil embolization, and flow diverter stents. Coil embolization is most commonly used but risks branch occlusion. Covered stent grafts preserve main artery flow but cannot be used at bifurcations. Stent-assisted coil embolization maintains branch flow but may not be feasible in tortuous vessels. Flow diverters are for complex aneurysms and branches but risk lack of occlusion and emboli. The optimal treatment depends on aneurysm type and location.

1. ENDOVASCULAR OPTIONS FOR
THE TREATMENT OF RENAL
ARTERY ANEURYSMS
Dr. Gerardo Peón Peralta

2. DISCLOSURES
- None

3. RENAL ARTERY ANEURYSMS
- RAAs are rare
- Incidence 0.01%
- Incidentally detected
- Mortality up to 80% in RRAAs
- Kidney loss in survivors
Henke PK, Cardneau JD, Welling TH, Upchurch GR, Wakefield TW, Jacobs LA, et al. Renal artery a
a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg 2001;234:454-63.

4. RENAL ARTERY ANEURYSMS
- Open repair
- Direct Repair
- Ex vivo repair & autotransplantation
González J, Esteban M, Andrés G, Linares E, Martínez-Salamanca JI.
Renal artery aneurysms. Curr Urol Rep 2014;15:376.

5. RENAL ARTERY ANEURYSMS
- Endovascular repair
- Coil Embolization
- Covered Stent Graft
- Liquid embolization
- Stent assisted coil embolization
- Flow Diverter Stents
Abath C, Andrade G, Cavalcanti D, Brito N, Marques R.
Complex renal artery aneurysms: liquids or coils? Tech Vasc Interv Radiol 2007;10: 29

6. RENAL ARTERY ANEURYSMS
- Endovascular repair
- Coil Embolization
- Covered Stent Graft
- Liquid embolization
- Stent assisted coil embolization
- Flow Diverter Stents
Abath C, Andrade G, Cavalcanti D, Brito N, Marques R.
Complex renal artery aneurysms: liquids or coils? Tech Vasc Interv Radiol 2007;10: 29

7. RENAL ARTERY ANEURYSMS
- Intervention is advisable for
- Aneurysms >2 cm in diameter
- Symptomatic
Coleman DM, Stanley JC. Renal artery aneurysms. J Vasc Surg
2015;62:779-85.

8. RENAL ARTERY ANEURYSMS
- Covered stent graft
- Main Renal Artery
- Fusiform Aneurysms
- Avoid Use on bifurcations
- Unless expendable branch
Zhongming Z, Min Y, Li S, Xiaoqiang T, Yinghua Z: Endovascular
treatment of renal artery aneurysms and renal arteriovenous fistulas;
JVascSurg: March 2013; 57 (3) 765-770

9. RENAL ARTERY ANEURYSMS
- Covered stent graft
- Main Renal Artery
- Fusiform Aneurysms
- Avoid Use on bifurcations
- Unless expendable branch
Zhongming Z, Min Y, Li S, Xiaoqiang T, Yinghua Z: Endovascular
treatment of renal artery aneurysms and renal arteriovenous fistulas;
JVascSurg: March 2013; 57 (3) 765-770

10. RENAL ARTERY ANEURYSMS
- Stent Assisted Coil Embolization
- Wide Neck Aneurysms
- Mantains flow through branch vessels
- Not feasible in small tortuous vessels
Xiaolong W, Yudong S, Yani W, et al: Manaagement ofmwide based
renal artery
Aneurysms using non covered stent-assisted coil embolization;

11. RENAL ARTERY ANEURYSMS
- Stent Assisted Coil Embolization
- Wide Neck Aneurysms
- Mantains flow through branch vessels
- Not feasible in small tortuous vessels
Xiaolong W, Yudong S, Yani W, et al: Manaagement ofmwide based
renal artery
Aneurysms using non covered stent-assisted coil embolization;

12. RENAL ARTERY ANEURYSMS
- Flow diverter stent
- Complex aneurysms
- Branch vessels
- Lack of occlusion require reintervention
- Risk of emboli
- Requires DAPT
Eldem G, Erdog! an E, Peynirciog! lu B, Arat A, Balkancı F. Endovascular
treatment of true renal artery aneurysms: a single center experience.
Diagn Interv Radiol 2019;25:62-70

13. RENAL ARTERY ANEURYSMS
- Flow diverter stent
- Complex aneurysms
- Branch vessels
- Lack of occlusion require reintervention
- Risk of emboli
- Requires DAPT
Eldem G, Erdog! an E, Peynirciog! lu B, Arat A, Balkancı F. Endovascular
treatment of true renal artery aneurysms: a single center experience.
Diagn Interv Radiol 2019;25:62-70

14. RENAL ARTERY ANEURYSMS
- Flow diverter stent
- Complex aneurysms
- Branch vessels
- Lack of occlusion require reintervention
- Risk of emboli
- Requires DAPT
Eldem G, Erdog! an E, Peynirciog! lu B, Arat A, Balkancı F. Endovascular
treatment of true renal artery aneurysms: a single center experience.
Diagn Interv Radiol 2019;25:62-70

15. CONCLUSIONS
Technique Indication Advantages Disadvantages
Coil embolization Sac-like narrow neck Used most often
Risk of segmental branch occlusion: risk of
coil migration
Covered stent graft Main renal artery
Used in fusiform aneurysms;
preserves flow through main
artery
Cannot be used at bifurcation; cannot be
used in presence of atherosclerosis; risk of
graft occlusion
Stent-assisted coil
embolization
Wide neck
Maintains flow through branch
vessels
Not feasible in small, tortuous
vessels
Flow diverter stents
Complex aneurysms,
branch
vessels
Maintains flow through branch
vessels
Lack of occlusion requiring reintervention,
risk of emboli, requires double antiplatelet
treatment

16. Thank you