Repair of Complex Renal Artery Aneurysms by Laparoscopic Nephrectomy with Ex-Vivo Repair and Autotransplantation

Objective: Renal artery aneurysms are being discovered more frequently due to increased use of non-invasive imaging. Complex renal artery aneurysms involving multiple secondary or tertiary branches are not amenable to in-vivo or endovascular treatment and therefore require ex-vivo repair with auto-transplantation, which is associated with significant incisional morbidity. To eliminate incisional morbidity and hasten recovery, we developed a technique of laparoscopic nephrectomy combined with backbench ex-vivo repair, followed by auto-transplantation through a small laparoscopic extraction incision. We report a case series of our initial experience with this technique.
Methods: Seven patients with complex renal artery aneurysms underwent laparoscopic nephrectomy and ex-vivo repair with multiple saphenous vein grafts and auto-transplantation through a small laparoscopic incision. The aneurysms ranged from 2.5-5.0 cm. In all cases, the aneurysm was resected ex-vivo, leaving multiple branch arteries that were extended with three separate saphenous vein grafts. Arterial inflow was then re-established with three sequential saphenous vein anastomoses to the external iliac artery (Figure 1). Urinary reconstruction was by standard Lich ureteroneocystostomy.
Results: Laparoscopic nephrectomy with ex-vivo repair of complex aneurysms was successfully employed in seven patients with previously untreatable aneurysms. There were no incisional morbidities and all patients had significant improvements in symptoms post-operatively. Renal function remained unchanged and there were no ureteral complications following surgery. The median hospital stay was five days.
Conclusions: Repair of complex renal artery aneurysms involving distal branch arteries remains a challenge. This new technique combines the advantages of minimally invasive surgery with the effectiveness of ex-vivo aneurysm repair.