Renal Artery Aneurysm

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

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]

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

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

Treatment

Surgical Reconstruction

  • xxx

Endovascular Treatment

  • xxxx

Prognosis

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

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]