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Renal Artery Aneurysm

Updated : May 7, 2024





Background

Renal artery aneurysm is a localized dilation or bulging of a blood vessel in the renal artery. It occurs when the artery wall thins and loses elasticity. It causes it to balloon out. This weakened area may rupture. This will lead to severe complications like internal bleeding. Aneurysms can be caused by conditions like atherosclerosis, inflammation, trauma, infection, genetic predisposition, or connective tissue disorders. Genetic factors like Ehlers-Danlos syndrome or Marfan syndrome can also lead to renal artery aneurysm. 

Epidemiology

Renal artery aneurysm is a rare condition. The reported incidence is about 0.01 to 1%. The acute cases may underestimate because of the asymptomatic cases and undetected. It occurs at any age. The adults whose age is between 40 to 60 are more diagnosed with this disease. It can affect both the male and female. 

Anatomy

Pathophysiology

Renal artery aneurysm (RAA) is caused due to some factors like atherosclerosis, fibromuscular dysplasia, genetic predisposition, infections, and connective tissue disorders. Atherosclerosis can weaken the renal artery wall and loss the elasticity. 

Fibromuscular dysplasia is a non-inflammatory vascular disease. It affects the muscular walls of arteries. Hemodynamic stress on the renal artery can be caused by the hypertension. It also led to aneurysm. Pregnancy-related hormonal changes can affect the vascular structure. Renal artery aneurysm may lead to internal bleeding and life-threatening complications.  

Etiology

Trauma 

Blunt or penetrating trauma to the abdomen or back can cause renal artery injury and development of aneurysm. 

Inflammatory Conditions 

Inflammatory diseases like vasculitis can affect the renal arteries. It contributes to the development of an aneurysm. Takayasu arteritis or polyarteritis nodosa are the conditions. 

Congenital Factors 

Congenital factors also develop vascular abnormalities. This can also lead to the renal artery aneurysm. 

Genetic Factors 

Genetic factors play an important role in RAA. Especially, when patient has a family history of vascular disease. 

Genetics

Prognostic Factors

Size of the aneurysm 

The presence of symptoms 

Overall health of the patient 

Clinical History

Physical Examination

Physical examination of the patients with RAA can vary. The factors which are include like the size, location and associated disease. Palpable lumps in the abdomen or flanks may be present. A noise may be heard over the belly around the renal artery. It can be detected via stethoscope.  

Hypertension is the most common condition which is associated with the RAA. During the examination, increased blood pressure is observed. Tenderness over the abdomen mainly nearby kidney indicate RAA. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

  • Renal artery stenosis  
  • Renal artery thrombosis  
  • Renal Infarction  

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

The treatment of renal artery aneurysm (RAA) depends on the factors like size, symptoms and overall health of the patients. Emergency surgical treatment is necessary to control the hemorrhage if patient has ruptured RAA. Nephrectomy is necessary if renal recovery is not possible because of the hemodynamic instability. Endovascular treatment like stent graft placement is used for the patients who are stable hemodynamically. It provides quick recovery. Long-term consequences and the recurrent surveillance are investigating. A careful approach that include a regular monitoring and treatment is given to the asymptomatic patients. The treatment is provided to the patients under the health care provider guidance. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Surgical treatment depends factors like size of the aneurysm, symptoms, overall health of patient and the presence of other medical conditions.  

Emergency Surgical Repair 

Urgent surgical treatment is necessary to treat the hemorrhage. It prevents the death from RAA. The midline technique and supraceliac aortic control are important. Once the renal artery is in control, then aortic cross clamp can be removed. Renal retrieval may be required in severe cases.  

Open Surgical Repair 

The traditional method is an incision to access the affected renal artery. The RAA is treated by excising the aneurysm and suturing the artery. The other way is by using a patch to strengthen the damaged vascular wall. 

Endovascular Repair 

This method involves the insertion of a catheter through blood arteries to the aneurysm. A stent graft is placed at the aneurysm location. It prevents the blood flow and build the artery wall. Endovascular repair is used for smaller aneurysms and patients who are not ready for the surgery. 

Endovascular Therapy 

Endovascular methods have advanced. The researchers are studying its applications to treat the RAA. Endovascular therapy is now recommended over open repair in medical facilities. More research is necessary for the long period of efficacy. Regular monitoring is necessary for the patient who are treated with endovascular methods.  

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

Renal Artery Aneurysm

Updated : May 7, 2024




Renal artery aneurysm is a localized dilation or bulging of a blood vessel in the renal artery. It occurs when the artery wall thins and loses elasticity. It causes it to balloon out. This weakened area may rupture. This will lead to severe complications like internal bleeding. Aneurysms can be caused by conditions like atherosclerosis, inflammation, trauma, infection, genetic predisposition, or connective tissue disorders. Genetic factors like Ehlers-Danlos syndrome or Marfan syndrome can also lead to renal artery aneurysm. 

Renal artery aneurysm is a rare condition. The reported incidence is about 0.01 to 1%. The acute cases may underestimate because of the asymptomatic cases and undetected. It occurs at any age. The adults whose age is between 40 to 60 are more diagnosed with this disease. It can affect both the male and female. 

Renal artery aneurysm (RAA) is caused due to some factors like atherosclerosis, fibromuscular dysplasia, genetic predisposition, infections, and connective tissue disorders. Atherosclerosis can weaken the renal artery wall and loss the elasticity. 

Fibromuscular dysplasia is a non-inflammatory vascular disease. It affects the muscular walls of arteries. Hemodynamic stress on the renal artery can be caused by the hypertension. It also led to aneurysm. Pregnancy-related hormonal changes can affect the vascular structure. Renal artery aneurysm may lead to internal bleeding and life-threatening complications.  

Trauma 

Blunt or penetrating trauma to the abdomen or back can cause renal artery injury and development of aneurysm. 

Inflammatory Conditions 

Inflammatory diseases like vasculitis can affect the renal arteries. It contributes to the development of an aneurysm. Takayasu arteritis or polyarteritis nodosa are the conditions. 

Congenital Factors 

Congenital factors also develop vascular abnormalities. This can also lead to the renal artery aneurysm. 

Genetic Factors 

Genetic factors play an important role in RAA. Especially, when patient has a family history of vascular disease. 

Size of the aneurysm 

The presence of symptoms 

Overall health of the patient 

Physical examination of the patients with RAA can vary. The factors which are include like the size, location and associated disease. Palpable lumps in the abdomen or flanks may be present. A noise may be heard over the belly around the renal artery. It can be detected via stethoscope.  

Hypertension is the most common condition which is associated with the RAA. During the examination, increased blood pressure is observed. Tenderness over the abdomen mainly nearby kidney indicate RAA. 

  • Renal artery stenosis  
  • Renal artery thrombosis  
  • Renal Infarction  

The treatment of renal artery aneurysm (RAA) depends on the factors like size, symptoms and overall health of the patients. Emergency surgical treatment is necessary to control the hemorrhage if patient has ruptured RAA. Nephrectomy is necessary if renal recovery is not possible because of the hemodynamic instability. Endovascular treatment like stent graft placement is used for the patients who are stable hemodynamically. It provides quick recovery. Long-term consequences and the recurrent surveillance are investigating. A careful approach that include a regular monitoring and treatment is given to the asymptomatic patients. The treatment is provided to the patients under the health care provider guidance. 

Surgical treatment depends factors like size of the aneurysm, symptoms, overall health of patient and the presence of other medical conditions.  

Emergency Surgical Repair 

Urgent surgical treatment is necessary to treat the hemorrhage. It prevents the death from RAA. The midline technique and supraceliac aortic control are important. Once the renal artery is in control, then aortic cross clamp can be removed. Renal retrieval may be required in severe cases.  

Open Surgical Repair 

The traditional method is an incision to access the affected renal artery. The RAA is treated by excising the aneurysm and suturing the artery. The other way is by using a patch to strengthen the damaged vascular wall. 

Endovascular Repair 

This method involves the insertion of a catheter through blood arteries to the aneurysm. A stent graft is placed at the aneurysm location. It prevents the blood flow and build the artery wall. Endovascular repair is used for smaller aneurysms and patients who are not ready for the surgery. 

Endovascular Therapy 

Endovascular methods have advanced. The researchers are studying its applications to treat the RAA. Endovascular therapy is now recommended over open repair in medical facilities. More research is necessary for the long period of efficacy. Regular monitoring is necessary for the patient who are treated with endovascular methods.