Renal artery aneurysms a 35-year clinical experience with 252 aneurysms in168 patients

Objective To define the relevance of treating renal artery aneurysms (RAAs) surgically. Summary Background Data Most prior definitions of the clinical, pathologic, and management features of RAAs have evolved from anecdotal reports. Contr oversy surrounding this clinical entity continues. Methods A retrospective review was undertaken of 168 patients (107 women, 6 1 men) with 252 RAAs encountered over 35 years at the University of Michiga n Hospital. Aneurysms were solitary in 115 patients and multiple in 53 pati ents. Bilateral RAAs occurred in 32 patients. Associated diseases included hypertension (73%), renal artery fibrodysplasia (34%), systemic atheroscler osis (25%), and extrarenal aneurysms (6.5%). Most RAAs were saccular (79%) and noncalcified (63%). The main renal artery bifurcation was the most comm on site of aneurysms (60%). RAAs were often asymptomatic (55%), with a diag nosis made most often during arteriographic study for suspected renovascula r hypertension (42%). Results Surgery was performed in 121 patients (average RAA size 1.5 cm), in cluding 14 patients undergoing unilateral repair with contralateral RAA obs ervation. The remaining 47 patients (average RAA size 1.3 cm) were not trea ted surgically. Operations included aneurysmectomy and angioplastic renal a rtery closure or segmental renal artery reimplantation, aneurysmectomy and renal artery bypass, and planned nephrectomy for unreconstructable renal ar teries or advanced parenchymal disease. Eight patients underwent unplanned nephrectomy, being considered a technical failure of surgical therapy. Dial ysis-dependent renal failure occurred in one patient. There were no periope rative deaths. Late follow-up (average 91 months) was available in 145 pati ents (86%). All but two arterial reconstructions remained clinically patent . Secondary renal artery procedures included percutaneous angioplasty, bran ch embolization, graft thrombectomy, and repeat bypass for late aneurysmal change of a vein conduit. Among 40 patients with clearly documented preoper ative and postoperative blood pressure measurements, 60% had a significant decline in blood pressure after surgery while taking fewer antihypertensive medications. Late RAA rupture did not occur in the nonoperative patients, but no lessening of this group's hypertension was noted.