Epidemiology

Demographics

• Incidence
  • By Autopsy: <0.01-0.09% ( J Vasc Surg, 2015) [MEDLINE]
  • By Angiogram: 0.3-2.5% (up to 9.7%) ( J Vasc Surg, 2015) [MEDLINE]
  • By CT Scan: 0.7% ( J Vasc Surg, 2015) [MEDLINE]
• Age
  • Peak Incidence is in the 6th Decade of Life (50’s): range 46-62 y/o ( J Vasc Surg, 2015) [MEDLINE]
• Sex
  • Female Predominance: approximately 72% of cases ( J Vasc Surg, 2015) [MEDLINE]
• Relationship to Cardiovascular Risk Factors
  • Most Patients Lack Cardiovascular Risk Factors (Other than Hypertension) ( J Vasc Surg, 2015) [MEDLINE]
• Relationship to Tobacco Abuse
  • Less than 33% of Patients Smoke Tobacco ( J Vasc Surg, 2015) [MEDLINE]
• Disease Association
  • Fibromuscular Dysplasia: associated in 68% of cases ( J Vasc Surg, 2015) [MEDLINE]
    • Fibromuscular Dysplasia is More Common in Females

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Physiology

Anatomy

• Size
  • Average Reported Size: 1.3-3.8 cm ( J Vasc Surg, 2015) [MEDLINE]
• Location
  • Approximately 66% Occur at Arterial Bifurcations ( J Vasc Surg, 2015) [MEDLINE]
• Shape
  • Most are Saccular ( J Vasc Surg, 2015) [MEDLINE]
• Number
  • Often Multiple ( J Vasc Surg, 2015) [MEDLINE]
• Laterality
  • Single Aneurysm Occur More Commonly on the Right Side ( J Vasc Surg, 2015) [MEDLINE]
  • Approximately 10-20% are Bilateral ( J Vasc Surg, 2015) [MEDLINE]
• Calcification
  • Approximately 18-68% are Calcified ( J Vasc Surg, 2015) [MEDLINE]
• Thromboembolism
  • Approximately 8-11% Demonstrate Thromboembolism ( J Vasc Surg, 2015) [MEDLINE]

Growth Rate

• Growth Rate is Approximately 0.06-0.6 mm/yr ( J Vasc Surg, 2015) [MEDLINE]

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Diagnosis

Kidneys-Ureters-Bladder (KUB) X-Ray (see Kidneys-Ureters-Bladder X-Ray, [[Kidneys-Ureters-Bladder X-Ray]])

• Renal Artery Aneurysm May Appear as “Signet Ring Calcification

Abdominal/Pelvic CT (see Abdominal-Pelvic Computed Tomography, [[Abdominal-Pelvic Computed Tomography]])

• Most Common Diagnostic Modality

Magnetic Resonance Angiogram (MRA) (see xxxx, [[xxxx]])

• Second Most Common Diagnostic Modality

Renal Ultrasound (see xxxx, [[xxxx]])

• xxxx

Angiogram (see xxxx, [[xxxx]])

• Recommended Preoperatively, Since Multiple Aneurysms May Be Present

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Clinical Manifestations

Asymptomatic

• Most Cases are Asymptomatic
  • Symptomatic in Only 4-23% of Cases
• Risk of Rupture
  • Most Series Report No Risk of Rupture (Followed Out to 270 Months) ( J Vasc Surg, 2015) [MEDLINE]
  • Risk of Rupture is Approximately 3-5% ( J Vasc Surg, 2015) [MEDLINE]
  • Pregnancy is Believed to Increase the Risk of Rupture (Due to Increased Blood Flow with Weakening of the Renal Artery Wall Elastic Tissue) ( J Vasc Surg, 2015) [MEDLINE]
    • Rupture Typically Occurs During the Third Trimester (and Sometimes, During Delivery)

Cardiovascular Manifestations

• Hypertension
  • Epidemiology
    • Hypertension is Present 70% of Cases (with some series reporting incidence up to 100% of cases) ( J Vasc Surg, 2015) [MEDLINE]
  • Physiologic Mechanisms
    • Coexistent Renal Artery Occlusive Disease
    • Compression or Kinking of Renal Artery Branches
    • Distal Renal Parenchymal Embolization
    • Hemodynamic Alterations from Turbulent Blood Flow Within the Renal Artery Aneurysm, Resulting in Decreased Distal Renal Artery Perfusion
  • Treatment
    • Often Improves After Treatment of the Renal Artery Aneurysm ( J Vasc Surg, 2015) [MEDLINE]

Gastrointestinal Manifestations

• Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]])
  • Epidemiology: may occur in cases with rupture
• Palpable Abdominal Mass (see Abdominal Mass, [[Abdominal Mass]])
  • Epidemiology: may be present

Renal Manifestations

• Chronic Kidney Disease (CKD) (see xxxx, [[xxxx]])
  • Epidemiology: occurs in 4-14% of cases ( J Vasc Surg, 2015) [MEDLINE]
• Flank Pain (see Flank Pain, [[Flank Pain]])
  • Epidemiology: may occur in cases with rupture
• Renal Bruit (see xxxx, [[xxxx]])
  • Epidemiology: may be present
• Retroperitoneal Hemorrhage (see xxxx, [[xxxx]])
  • Epidemiology: in cases with rupture

Vascular Manifestations

• Other Arterial Aneurysms
  • Epidemiology: present in 7-30% of cases ( J Vasc Surg, 2015) [MEDLINE]
  • Clinical
    • Aortic Aneurysm
    • Iliac Artery Aneurysm
    • Visceral Artery Aneurysm

Other Manifestations

• Hemorrhagic Shock (see xxxx, [[xxxx]])
  • Epidemiology: in cases with rupture

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Treatment

Surgical Reconstruction

• xxx

Endovascular Treatment

• xxxx

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Prognosis

• Non-Gestational Mortality Rate (with Rupture): <10% ( J Vasc Surg, 2015) [MEDLINE]

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References

• The contemporary management of renal artery aneurysms. J Vasc Surg. 2015 Apr;61(4):978-84. doi: 10.1016/j.jvs.2014.10.107 [MEDLINE]
• Renal artery aneurysms. J Vasc Surg. 2015 Sep;62(3):779-85. doi: 10.1016/j.jvs.2015.05.034 [MEDLINE]
• Treatment of renal artery aneurysms. J Cardiovasc Surg (Torino). 2015 Aug;56(4):559-65 [MEDLINE]