Management of Renal Artery Aneurysms: Surgery, Endovascular Therapy and Observation

OBJECTIVES: This study reports our experience with treatment and observation of renal artery aneurysms(RAAs).
METHODS: We performed a retrospective review of all patients evaluated by the New York University Vascular Surgery Department from 1998 to 2008. Thirty-three patients(17 males/16 females) were identified with RAAs. Average age was 63±16years. Nineteen patients underwent either open surgery(n=8) or percutaneous intervention(n=11). Indications for RAA treatment were size >2.0 cm(18/19), identification of the RAA during pregnancy(1/19), RAA in a non-pregnant female of child bearing age(4/19), symptoms of hypertension and/or pain (7/19) and a concomitant ipsilateral renal cell cancer(1/19). The remaining fourteen RAA patients were observed.
RESULTS: Six of 11 patients treated via an endovascular approach underwent successful exclusion with placement of an endovascular graft(4 Viabahn, 2 Atrium). The remaining 5 endovascular patients had saccular aneurysms that were amenable to coil embolization. Seven of the 8 patients requiring open surgery for their RAA had a primary aneurysmectomy and arterioplasty with, or without vein patch closure. One patient required open surgery with nephrectomy for a concomitant ipsilateral renal cell cancer. Average length of stay was 2.3 days for the endovascular patients and 6.2 days for the open surgical patients. There was no 30-day mortality or decline in renal function in either the endovascular or open surgical group. All 6 stent grafts remain patent with excluded RAAs at 23 ± 18 months(range 6-48 months). The observed group had an average RAA size of 1.7 cm±.5cm, with an average RAA growth rate of <1mm/year. Mean follow-up for the observation group was 49 months. There were no aneurysm ruptures or aneurysm related deaths.
CONCLUSIONS: RAAs can be safely treated via an endovascular or open approach. In appropriately selected patients, an endovascular approach can offer successful exclusion with a shorter hospital stay. RAAs <2.0 cm have a slow rate of growth and may be observed in asymptomatic patients who are not females in their child bearing years.