Primary dissecting aneurysm of the renal artery

Spontaneous Renal Artery Dissection Resulting in Renal Infarction: A Case Report and Review of the Literature

Spontaneous renal artery dissection is a rare disease and an uncommon cause of renal infarction. The patient was a man who presented to the emergency room with sudden-onset right flank pain. Computed tomography revealed right renal infarction; thus, anticoagulation was initiated. Renal angiography revealed luminal narrowing of the segmental artery to the superior pole of right kidney without a dissection flap or false lumen. We stopped anticoagulation due to a lack of evidence of thrombi or luminal narrowing of the dissected vessels. When patients present with acute flank pain, it is important to suspect renal infarction and to perform a correct diagnostic workup, even when the patient shows normal urinalysis results and a normal LDH value.

Une cause rare d’hématurie : rupture d’anévrisme de l’artère rénale

The authors report a case of ruptured renal artery aneurysm in a 78 year old patient presenting with macroscopic hematuria. The rare occurrence of this entity and the value of imaging for diagnosis are discussed.

Spontaneous Dissecting Aneurysm of the Renal Artery: A Case Report

Primary dissecting aneurysms of the renal artery are exceedingly rare. The triad of flank pain, hematuria, and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition. We report a case of spontaneous dissecting aneurysm of the renal artery treated using conservative medical treatment. The diagnosis, therapeutic management, and outcome are discussed.

Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation1

PURPOSE

We undertook this study to assess the outcome of spontaneous dissection of the renal artery and its branches surgically treated with extracorporeal reconstruction and autotransplantation.

SUBJECTS

Between 1975 and 1996, 15 consecutive patients (19 kidneys) with spontaneous renal artery dissection underwent renal artery reconstruction. Fourteen patients had accelerated hypertension. Five patients had impaired renal function. In 14 patients the dissection was associated with fibrodysplasia, and in 1 patient it was related to arteriosclerosis.

INTERVENTION

In 17 kidneys extracorporeal reconstruction and autotransplantation was used. The renal artery of 1 kidney was reconstructed in situ. One primary nephrectomy was performed.

RESULTS

There were no operative deaths or major morbidity. All but 1 reconstruction was successful (94.4%). Results at follow-up (range, 1-8 years) were favorable in 14 patients; 79% had satisfactory blood pressure control, and all patients had normal renal function, including those with impaired renal function preoperatively.

CONCLUSIONS

Extracorporeal reconstruction and autotransplantation can be effectively used in patients with spontaneous renal artery dissection located in or extending into the distal branches. Early recognition and appreciation of the clinical presentation of spontaneous renal artery dissection are important.

Aneurysms of the renal artery and its branches

During the last ten years, 29 aneurysms of the renal artery, observed in 20 patients were operated on. These cases represent 10% of the total number of renal vascularization procedures performed during the same period. Diagnosis was made most often during the workup for arterial hypertension (16 patients). There were 20 cases of sacciform aneurysms, eight cases of fusiform aneurysms, usually associated with stenotic lesions, and one case of dissecting aneurysm. Fibromuscular dysplasia was the principal etiological factor. A total of 22 kidneys were involved. Restoration was performed "in situ" in 15 cases (21 aneurysms), using aortorenal bypass in fusiform aneurysms and usually aneurysmorrhaphy for sacciform aneurysms. Six cases (seven aneurysms) were treated with "ex situ" surgery. Primary nephrectomy was performed in one patient. There was no operative mortality. Early occlusion occurred in two cases, resulting in secondary nephrectomy. During a mean follow-up period of 51 months, there were no secondary occlusions. Blood pressure control was obtained in 14 patients (87%). Surgical management is recommended for most renal artery aneurysms. Repair using "in situ" techniques is usually feasible and provides satisfactory long-lasting results in most cases.

Spontaneous resolution of bilateral renal artery dissection: a case report

We report a case of simultaneous bilateral dissection of the renal arteries with partial renal infarction. Of interest is the fact that the dissection resolved spontaneously during the 1-year followup. The radiology, including angiography, computerized tomography and ultrasonography, findings are described. The etiology and treatment of isolated dissection of the renal artery also are discussed.

Dynamic CT diagnosis of primary dissecting aneurysm of the renal artery

Incremental dynamic CT clearly demonstrated primary dissecting aneurysm of the renal artery in a 36-year-old man presenting with loin pain. A sustained dense bolus in abdominal dynamic CT is vital if branch artery abnormalities are to be diagnosed.