General case of the day. Left renal vein aneurysm

Endovascular Occlusion of a Renal Arteriovenous Fistula with Renal Vein Aneurysm Formation for Rupture Prevention

Purpose

To report the effectiveness of left renal artery (LRA) occlusion using Amplatzer Vascular Plug (AVP) II as treatment for a high-flow renal arteriovenous fistula (RAVF) with multiple renal vein aneurysms (RVA) to prevent aneurysm rupture and cardiac decompensation.

Case Report

A 59-year-old female suffering from a post-traumatic RAVF presented with tachycardia and increased cardiac output (CO). Doppler ultrasonography and computed tomography (CT) scan revealed a high-flow RAVF with multiple RVAs and unilateral critically reduced kidney function. Appreciating recent interventional therapeutic advances, the patient was treated with endovascular placement of AVP II into the left renal artery (LRA) resulting in complete occlusion of the RAVF to effectively reduce the risk of RVA rupture and cardiac decompensation. No anti-platelet medication was administrated after the occlusion of the LRA. The patient's physical capacity improved since right heart volume strain was normalized, and CO was reduced.

Conclusion

Transbrachial AVP II occlusion of the LRA is effective to occlude high-flow RAVFs to prevent risk of life-threatening RVA rupture. Additional follow-up is warranted to verify long-term effectiveness of this approach.

Ex Vivo Resection and Renal Autotransplantation for the Treatment of a Large Renal Vein Aneurysm Causing Recurrent Pulmonary Embolism and a Coexisting Vascular Malformation: A Case Report

A 36-year-old young woman with a medical history of recurrent pulmonary embolism and chronic pelvic pain was admitted to our hospital. Contrast-enhanced imaging techniques revealed a large left renal vein aneurysm with a coexisting vascular mass. The patient was operated on electively, and the left kidney was autotransplanted to the right ileac fossa following the ex vivo resection of the vascular mass and the left renal vein aneurysm. Herein, we report an unusual coexistence of a vascular mass and recurrent pulmonary embolism treated successfully with our surgical treatment strategy.

Imaging features of left ovarian and renal venous aneurysms: two case reports and literature review

Venous aneurysms rarely occur in the visceral veins. We report two extremely rare cases of venous aneurysms, one of the ovarian vein and the other one of the renal vein. The aneurysms were depicted on grayscale and color Doppler ultrasonography as anechoic saccular structures with compressibility and blood flow. Pulsed Doppler ultrasonography showed venous flow. Contrast-enhanced computed tomography showed aneurysmal venous dilatation. We diagnosed left ovarian and renal venous aneurysms. We also review the clinical presentation and implications of visceral venous aneurysms.

Late renal vein aneurysm following living related renal transplant

Renal vein aneurysms are rare; there are less than 10 reported cases. As of yet there have been no reported cases of renal vein aneurysm following renal transplantation. We present a case of an incidentally discovered renal vein aneurysm following uncomplicated living related renal transplant. The lesion was discovered 4 years after the transplant through abdominal ultrasound investigation of new right lower quadrant discomfort. Magnetic resonance imaging confirmed the presence of a 2.3-cm thrombosed renal vein aneurysm of the main renal vein. This case report highlights the rare nature of these events, the diagnostic challenges and the lack of satisfactory management guidelines in these cases.

Right renal vein aneurysm discovered incidentally during laparoscopic nephrectomy

Renal vein aneurysms are exceedingly rare. There are only 8 reported cases in the literature. We present the first case of a renal vein aneurysm discovered incidentally during a laparoscopic radical nephrectomy and discuss its intraoperative management.

Visceral venous aneurysms: clinical presentation, natural history and their management: a systematic review

AIM

Aneurysms of the visceral veins are considered rare clinical entities. The aim is to assess their clinical presentation, natural history and management.

METHODS

An electronic search of the pertinent English and French literature was undertaken. All studies reporting on aneurysms of visceral veins were considered. Cases describing patients with arterial-venous fistulae and extrahepatic or intra-hepatic portosystemic venous shunts were excluded.

RESULTS

Ninety-three reports were identified, including 176 patients with 198 visceral venous aneurysms. Patients' age ranges from 0 to 87 years, and there is no apparent male/female preponderance. The commonest location of visceral venous aneurysms is the portal venous system (87 of 93 reports, 170 of 176 patients, 191 of 198 aneurysms). Aneurysms of the renal veins and inferior mesenteric vein are also described. Portal system venous aneurysms were present with abdominal pain in 44.7% of the patients, gastrointestinal bleeding in 7.3%, and are asymptomatic in 38.2%. Portal hypertension is reported in 30.8% and liver cirrhosis in 28.3%. Thrombosis occurred in 13.6% and rupture in 2.2% of the patients. Adjacent organ compression is reported in 2.2% (organs compressed: common bile duct, duodenum, inferior vena cava). The management ranged from watchful waiting to intervention. In 94% of the cases, aneurysm diameter remained stable and no complications occurred during follow-up. In most of the cases, indications for operation were symptoms and complications. Six cases of renal vein aneurysm are reported; three of them were asymptomatic. Three of these patients were treated surgically.

CONCLUSION

The most frequent location of visceral venous aneurysms is the portal venous system. They are often associated with cirrhosis and portal hypertension. They may be asymptomatic or present with abdominal pain and other symptoms. Watchful waiting is an appropriate treatment, except when complications occur. Most common complications are aneurysm thrombosis and rupture. Other visceral venous aneurysms are extremely rare.