Endovascular management of a large renal artery aneurysm: a case report and review of the literature

Management of Renal Artery Aneurysms and an Arteriovenous Shunt in a Hemophilic Patient: A Case Report

This case report details the management of a 66-year-old male with hemophilia A (HA) who presented with recurrent hematuria, and was found to have renal artery aneurysms and was subsequently diagnosed with a renal arteriovenous (AV) shunt. While the primary focus centers on the successful endovascular coil embolization of renal artery aneurysms, the concomitant presence of the AV shunt accentuates the significance of this case. Imaging techniques were crucial in the discovery of renal aneurysms and the diagnosis of the AV shunt malformation of the renal artery. This included an ultrasound, CT-angiography and digital subtraction angiography. The treatment approach employed prioritized endovascular coil embolization for its efficacy and reduced morbidity. Following the initial successful embolization, the identification of the AV shunt during subsequent embolization led to its targeted treatment. The case was also complicated by acute prostatitis that was treated medically. The patient's HA required careful administration of coagulation factor replacement therapy to control bleeding throughout the process. This case highlights the importance of reporting on the management of rare and complex pathologies to better understand and guide future treatments, especially involving this rare combination of renal AV shunts and hemophilia A.

Conservative treatment of blunt traumatic right renal venous pseudoaneurysm: A case report

Introduction

Venous pseudoaneurysm is uncommon in blunt trauma patients, and renal venous pseudoaneurysm is especially rare, even though renal trauma occurs in approximately 8–10 % of abdominal trauma cases. There is controversy regarding the modality of treatment between surgery, conservative care, and radiologic intervention to manage renal venous pseudoaneurysms. We would like to share our experience treating blunt trauma patients having renal venous pseudoaneurysm with conservative care.

Presentation of case

A 53-year-old female patient was transferred to our trauma center following a pedestrian accident. Contrast-enhanced abdominal computed tomography (CT) showed right renal injury (grade II) with partial infarction (approximately 30–40 %) and peri-renal hematoma confined to Gerota's fascia without extravasation, a 3 cm sized right renal venous pseudoaneurysm, and a liver laceration (grade III) with a small amount of perihepatic hemoperitoneum. Since her vital signs were stable, with no decrease in the hemoglobin level in the short-term follow-up laboratory test, we decided to treat the patient conservatively in the trauma intensive care unit without angioembolization or surgery. The patient was discharged on the 14th day after OR/IF surgery for a right distal tibiofibular fracture. On a CT scan performed 1 month after discharge, a peri-renal hematoma was no longer observed, and the renal venous pseudoaneurysm had nearly improved.

Discussion

Patients with renal arterial injury with unstable vital signs require surgery or angioembolization. Even if vital signs are stable, arterial pseudoaneurysms are more likely to rupture; therefore, surgery or angioembolization is required. In contrast, venous pseudoaneurysms can be managed conservatively compared to intervention or surgery in vitally stable patients because they have a lower possibility of rupture due to relatively low pressure.

Conclusion

Renal venous pseudoaneurysms are very rare. Surgery, conservative care, and radiologic intervention should be considered depending on the patient's condition. Because venous blood flow is slower than arterial blood flow, renal venous pseudoaneurysm can be treated with conservative care if there are no injuries requiring further management and if the patient's vital signs are stable.

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Renal venous pseudoaneurysm is very rare in blunt abdominal trauma.

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The choice of treatment modality among surgery, conservative care, and radiologic intervention for renal venous pseudoaneurysm remains controversial.

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Renal venous pseudoaneurysms can be treated with conservative care if there are no injuries that require further management and the patient's vital signs are stable.

Renal Artery Catheterization for Microcapsules' Targeted Delivery to the Mouse Kidney

The problem of reducing the side effects associated with drug distribution throughout the body in the treatment of various kidney diseases can be solved by effective targeted drug delivery. The method described herein involves injection of a drug encapsulated in polyelectrolyte capsules to achieve prolonged local release and long-term capillary retention of several hours while these capsules are administered via the renal artery. The proposed method does not imply disruption (puncture) of the renal artery or aorta and is suitable for long-term chronic experiments on mice. In this study, we compared how capsule size and dosage affect the target kidney blood flow. It has been established that an increase in the diameter of microcapsules by 29% (from 3.1 to 4.0 μm) requires a decrease in their concentration by at least 50% with the same suspension volume. The photoacoustic method, along with laser speckle contrast imaging, was shown to be useful for monitoring blood flow and selecting a safe dose. Capsules contribute to a longer retention of a macromolecular substance in the target kidney compared to its free form due to mechanical retention in capillaries and slow impregnation into surrounding tissues during the first 1-3 h, which was shown by fluorescence tomography and microscopy. At the same time, the ability of capillaries to perform almost complete "self-cleaning" from capsular shells during the first 12 h leads to the preservation of organ tissues in a normal state. The proposed strategy, which combines endovascular surgery and the injection of polymer microcapsules containing the active substance, can be successfully used to treat a wide range of nephropathies.