Isolated dissecting aneurysm of the renal artery

A rare case of renal artery aneurysm - dawning of new treatment approach

Renal artery aneurysms are a rare occurrence, with a prevalence of about <1%. The majority of patients are asymptomatic and are diagnosed through incidental findings on imaging. In very rare occurrences, the aneurysm can rupture and cause significant morbidity and even death.

Accelerated hypertension with encephalopathy due to an isolated dissection of a renal artery branch vessel

Typical causes of renovascular hypertension include intramural atherosclerotic lesions of the main renal arteries or their branches and fibromuscular dysplasia of the renal arterial wall with luminal narrowing. We report a patient with new-onset, accelerated hypertension (blood pressure 220/140 mm Hg, status epilepticus, retinal hemorrhages) secondary to a dissection of the anterior division of the right renal artery that was accompanied by hyperreninemia, hyperaldosteronism, and hypokalemia. At presentation in the untreated state, unstimulated plasma renin activity and the serum aldosterone level were markedly elevated. Following right nephrectomy, blood pressure levels normalized without antihypertensive therapy, and plasma renin activity, serum aldosterone and potassium levels normalized. Histologic study of the right renal artery showed an isolated dissection of the anterior branch of the vessel between the muscularis and adventitia that created marked reduction in luminal diameter and renal ischemia. There was no evidence of any other vascular abnormalities, atherosclerosis, or fibromuscular dysplasia. These findings demonstrate that an isolated dissection of a branch of the renal artery may induce profound hyperreninemia and represents a rare, reversible etiology for accelerated hypertension associated with acute encephalopathy.

Extracorporeal repair of renal artery branch lesions

Complex renal artery lesions which formerly would have been treated by nephrectomy may now be reconstructed by extracorporeal surgery and autotransplantation. Our experience in 15 patients (17 operations) with renal artery lesions extending into its branches or confined to them is described. Two patients underwent separate operations on both sides. The indications for surgery were severe renovascular hypertension (10 cases), renal artery aneurysm, (5 cases) and deteriorating renal function (2 cases). Overall clinical results after a mean follow up of 3 years were considered excellent in 13 procedures (11 patients). Improvement in 2 patients and failure in the other 2, who ultimately underwent nephrectomy. Discussion is focussed on results, vascular indications, (namely aneurysm, stenosis, dissecting aneurysm and trauma) and surgical techniques. Preservation of functioning renal tissue should be the ultimate goal of renovascular surgery where the ex vivo technique, when indicated, will achieve favorable results in most patients.

Traumatic renal artery dissection

Hypertension consequent upon traumatic subintimal dissection of the renal artery is described in 2 cases. The pathogenesis and treatment of this uncommon condition are presented.

Spontaneous dissecting aneurysm of the renal arteries. A case and a review of the literature

A case of dissecting aneurysm of the renal arteries is presented. The patient suffered from an intractable subarachnoid bleeding and the kidneys had been selected for transplantation. One kidney was never transplanted, the other was transplanted and rejected after few days. Dissecting aneurysms were present in the main artery and its major ramifications in both kidneys. Many investigators have claimed that dissecting aneurysm and fibromuscular dysplasia of the renal artery are different stages of but one disease. A review of the accumulated literature on dissecting aneurysm of the renal artery reveals, however, that this disorder shows a preponderance of middle-aged men, whereas fibromuscular dysplasia of the renal artery affects adolescent girls. It is concluded that the two disorders of the renal artery most likely represent different vascular diseases.