images Vol. 3, No. 1; 2019; pp 32–33
DOI: 10.26676/jevtm.v3i1.69

Corresponding author:

(Sharon) Yen M Chan, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.

Email: sharonyenming.chan@nhs.net

Author contributions: (Sharon) Yen M Chan: literature review and drafting of the manuscript; Grigoris Athanasiadis, Athanasios Pantos, and Stavros Spiliopoulos: idea conception; Alasdair Wilson: idea conception, image acquisition, and critical revision of the manuscript.

Conflicts of interest: None.

Funding: None.

Presentation: British Society of Endovascular Surgery (BSET) Annual Meeting 2018—Poster presentation.

© 2019 CC BY 4.0 – in cooperation with Depts. of Cardiothoracic/Vascular Surgery, General Surgery and Anesthesia, Örebro University Hospital and Örebro University, Sweden

Emergency Embolization of a Ruptured Renal Artery Aneurysm

S Yen M Chan MRCS (Ed)1, Grigoris Athanasiadis MD2, Athanasios Pantos MD 3, Stavros Spiliopoulos PhD3 and Alasdair Wilson MD1

1Vascular Surgery Department, Aberdeen Royal Infirmary, Scotland, UK

2Urology Department, Aberdeen Royal Infirmary, Scotland, UK

3Interventional Radiology Department, Aberdeen Royal Infirmary, Scotland, UK

Keywords: Emergency; Renal Artery Aneurysm; Endovascular

Received: 15 September 2018; Accepted: 30 October 2018

Renal artery aneurysm (RAA) is a rare clinical entity with an incidence rate of 0.1% [1]. Clinically most patients are asymptomatic [2], but mortality from acute rupture is 10% [3]. Conventional management includes open surgery which may, unfortunately, require a nephrectomy [4]. However, the success of endovascular interventions has led to a paradigm shift in treatment [4].

A 77-year-old medically frail woman presented to the physicians with symptomatic anemia of hemoglobin 4.6 g/L. At this time, she was hemodynamically stable. Past medical history included hypertension and hypothyroidism. Clinical examination demonstrated a soft abdomen with a palpable mass in the left flank and upper quadrant. She was transfused with 3 units of blood and a CT angiogram was performed. This demonstrated a 7 × 6 cm ruptured left RAA associated with a retroperitoneal hematoma (Fig. 1).

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Figure 1 Computed tomography angiogram demonstrating a 7 x 6 cm ruptured left renal artery aneurysm (black arrow) associated with retroperitoneal hematoma (white arrow).

After the CT scan, the patient became hemodynamically unstable with a Glasgow Coma Scale of 6. A decision was made to attempt endovascular control of the hemorrhage as she was unfit for a laparotomy or nephrectomy.

At digital subtraction angiography, the renal artery was selectively catheterized using a 5 Fr angiographic catheter (Sim 1, Cordis, USA) and a microcatheter (Progreat, Terumo, Japan) advanced within the sac of the aneurysm. The sac was embolized using 10 large-diameter detachable coils (Concerto, Medtronic, USA) and a 12 mm vascular plug (Amplatzer, Abbott, USA) deployed at the neck (Fig. 2). Post-operative duplex confirmed thrombosis of the left RAA and the patient recovered without sequelae.

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Figure 2 Digital subtraction angiography demonstrating concerto coils filling the aneurysm sac. Due to concerns over the length of the neck, an AMPLATZER plug was deployed.

REFERENCES

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[2] Tham G, Ekelund L, Herrlin K, Lindstedt EL, Olin T, Bergentz SE. Renal artery aneurysms. Natural history and prognosis. Ann Surg. 1983;197:348–52.

[3] Gonzalez J, Esteban M, Andres G, Linares E, Martinez-Salamanca JI. Renal artery aneurysms. Curr Urol Rep. 2014;15:376. doi:10.1007/s11934-013-0376-z.

[4] Orion KC, Abularrage CJ. Renal artery aneurysms: movement toward endovascular repair. Semin Vasc Surg. 2013; 26:226–32. doi:10.1053/j.semvascsurg.2014.06.007.