L S Silski1, M L Henry1, A Rajab1, R P Pelletier2. 1. Division of Transplantation, Department of General Surgery, The Ohio State University Wexner Medical Centers, Columbus, Ohio, USA. 2. Division of Transplantation, Department of General Surgery, The Ohio State University Wexner Medical Centers, Columbus, Ohio, USA. Electronic address: Ronald.pelletier@osumc.edu.
Abstract
BACKGROUND: Renal artery aneurysms are increasingly being detected incidentally during diagnostic imaging using magnetic resonance imaging, computed tomography, or angiography performed for evaluation of other diseases. Our understanding of their natural history and surgical management has evolved significantly during the past two decades. PATIENTS AND METHODS: Three patients with incidentally identified renal artery aneurysms have been referred to our renal transplantation program in the last 3 years. All three had aneurysms located at renal artery branches making endovascular repair challenging and thus underwent hand-assisted laparoscopic nephrectomy with ex vivo aneurysmectomy, with heterotopic autotransplantation in two cases and allotransplantation in the third case. RESULTS: All three cases resulted in successful renal artery aneurysm repair and reimplantation and good renal function of the implanted kidney. CONCLUSIONS: Laparoscopic nephrectomy with ex vivo aneurysm repair and reimplantation can be a successful approach to surgical management, especially in cases where the aneurysm involves multiple artery branches and endovascular repair is challenging. Given the excellent results with this surgical approach, living and deceased donor kidneys with aneurysms should be strongly encouraged if deemed reparable. Published by Elsevier Inc.
BACKGROUND:Renal artery aneurysms are increasingly being detected incidentally during diagnostic imaging using magnetic resonance imaging, computed tomography, or angiography performed for evaluation of other diseases. Our understanding of their natural history and surgical management has evolved significantly during the past two decades. PATIENTS AND METHODS: Three patients with incidentally identified renal artery aneurysms have been referred to our renal transplantation program in the last 3 years. All three had aneurysms located at renal artery branches making endovascular repair challenging and thus underwent hand-assisted laparoscopic nephrectomy with ex vivo aneurysmectomy, with heterotopic autotransplantation in two cases and allotransplantation in the third case. RESULTS: All three cases resulted in successful renal artery aneurysm repair and reimplantation and good renal function of the implanted kidney. CONCLUSIONS: Laparoscopic nephrectomy with ex vivo aneurysm repair and reimplantation can be a successful approach to surgical management, especially in cases where the aneurysm involves multiple artery branches and endovascular repair is challenging. Given the excellent results with this surgical approach, living and deceased donor kidneys with aneurysms should be strongly encouraged if deemed reparable. Published by Elsevier Inc.