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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2004 June;11(2):59-63
Ex vivo surgery of aneurysms of branches of the renal arteries
Varetto G., Favre J. P., Barral X.
CHU, Service de Chirurgie Cardio-vasculaire Hôpital Nord, Saint Étienne, France
Aim. Renal artery aneurysms (RAA) are unusual lesions which have a frequency of 0.09% in the whole population and of 1-2.5% among people with hypertension, who underwent renal angiography. These lesions are often situated at the bifurcation or in branches of renal arteries, and for these reasons they are usually not treatable with endovascular techniques. In these cases the autograft ex vivo surgical recontructions seem to be the most reliable treatment, with good long-time results.
Methods. Between January 1, 1981 and December 31 2001 we operated 49 cases of renal artery aneurysms, 43 of which (in 38 different patients) were treated with ex vivo surgery. Hypertension had been diagnosed in 29 patients, of which 5 had an associated renal insufficiency. In 23 cases we utilized for reconstruction the hypogastric artery, in 7 the femoral superficial artery and in 13 the great saphenous vein. The surgery follow-up consisted of angiography and renal function check-up for the 6 months after surgery and annual checks with duplex scanner ultrasonography and scintigraphy of the renal district.
Results. A decease for major thrombophilia and a kidney infarction with loss of the organ due to acute thrombosis was found during the early follow-up (6 months). Two angioplasties of the graft and 2 femoro-femoral cross-over bypasses for external iliac artery thrombosis were performed during the long-term follow-up period. Among the 28 surviving hypertensive patients, 9 are still hypertensive and 19 have normal arterial pressure without any pharmacological therapy. Two patients (out of 5 with renal insufficiency) now have a normal renal function.
Conclusion. Ex vivo surgery is effective in the treatment of renal artery aneurysms. Results show a low degeneration rate: more than 90% of kidneys have normal function after a 7.5 year follow-up. The use of autograft is often the explanation of these good results. In children and young patients, treating the associated dysplastic stenosis allows a normalization of blood pressure values.