eMedicine Specialties > Vascular Surgery > Medical Topics

Renal Artery Aneurysm: Workup

Author: Wesley K Lew, MD, Resident, Department of General Surgery, University of Southern California
Coauthor(s): Fred A Weaver, MD, Professor of Surgery, University of Southern California; Chief, Division of Vascular Surgery, Director of Noninvasive Vascular Laboratory, Program Director of Vascular Surgery, University of Southern California University Hospital;; Christian A Otero, MD, Staff Physician, Department of Surgery, Jackson Memorial Hospital, University of Miami School of Medicine; Raid Sawaqed, MD, Staff Physician, Department of General Surgery, Catholic Health Partners of Chicago; Nicholas D Garcia, MD, Chief of Surgery, Exeter Health Resources; Director, Board of Directors, Core Physician Services; Medical Director, Vascular Lab, Exeter Hospital; Mark D Morasch, MD, Associate Professor of Surgery, Division of Vascular Surgery, Northwestern University, The Feinberg School of Medicine
Contributor Information and Disclosures

Updated: Sep 17, 2008

Workup

Laboratory Studies

  • A complete blood cell count, chemistry panel, coagulation profile, and urinalysis should be performed prior to any surgical intervention.
  • Special attention should be made to the BUN and creatinine, as they are indicative of renal function, and can be followed to assure that no renal damage exists if the decision is made to manage a RAA nonoperatively. 
  • In a patient with hypertension, RAA, and no renal artery stenosis, other endocrine sources of hypertension should be excluded. These include the following:
    • Pheochromocytoma - A 24-hour urine collection for vanillylmandelic acid, metanephrine, and normetanephrine
    • Primary aldosteronism - Serum potassium
    • Cushing syndrome - Cortisol levels
    • Carcinoid - Urinary 5-hydroxyindoleacetic acid

Imaging Studies

  • Because most RAAs are asymptomatic and are found incidentally during a workup for other intra-abdominal pathology, imaging studies are required only for preintervention planning or longitudinal follow-up care.
  • Ultrasound (US) with duplex examination is the least invasive imaging study. Two-dimensional ultrasound forms an anatomic picture based on the time delay of ultrasonic pulses reflected from structures. Vessel walls reflect ultrasound waves and appear white and blood absorbs and scatters ultrasound waves appearing black. Normal vessels appear as dark-filled, white-walled structures. Duplex uses Doppler-shift measurement to detect the flow direction and velocity of blood. This can be useful in identifying renal artery stenosis. Ultrasound can also be used in determining the how functional a kidney is by measuring its size. Of note, the quality of imaging is highly operator dependent and may be limited by the patient's body habitus.
  • CT scan is the most widely available and reproducible imaging modality. It is the test of choice for diagnosis and follow-up. The anatomical resolution is superior to that of US (see Image 3). The advent of CT angiography and 3-dimensional reconstruction can allow for accurate preinterventional planning. Because intravenous iodinated dye must be used, its only real limitation is in patients who have a life-threatening dye allergy or impaired renal function. Non–life-threatening dye allergies can be managed with premedication with Benadryl (histamine-1 receptor antagonist), cimetidine (histamine-2 receptor antagonist), and Solu-Medrol.

  • (A) Computed tomography scan and (B) arteriogram ...

    (A) Computed tomography scan and (B) arteriogram of the same patient with a saccular left renal artery aneurysm at a segmental renal artery branch.

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    (A) Computed tomography scan and (B) arteriogram ...

    (A) Computed tomography scan and (B) arteriogram of the same patient with a saccular left renal artery aneurysm at a segmental renal artery branch.

  • MRA with gadolinium enhancement and 3-dimensional reconstruction can produce images similar in quality to those with arteriography (see Image 4). However, this technology is not as readily available as US or CT and is a more expensive test.

  • Magnetic resonance imaging of a patient with 2 le...

    Magnetic resonance imaging of a patient with 2 left renal artery aneurysms. Both are saccular, one is at a segmental branch (closed arrow) and the other is intrarenal (open arrow). Of note: this patient also has a congenital absence of the right kidney.

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    Magnetic resonance imaging of a patient with 2 le...

    Magnetic resonance imaging of a patient with 2 left renal artery aneurysms. Both are saccular, one is at a segmental branch (closed arrow) and the other is intrarenal (open arrow). Of note: this patient also has a congenital absence of the right kidney.

  • Arteriography is the most invasive test but can be useful for helping define unclear anatomy seen on prior examinations (see Image 2 and Image 3). For the most part, arteriography as a diagnostic test has been supplanted by CT angiography and MRA.

  • (A) Aortogram with calcified left renal artery an...

    (A) Aortogram with calcified left renal artery aneurysm (RAA). (B-C) Same RAA in magnified view, demonstrating the RAA is saccular, arising from the main renal artery.

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    (A) Aortogram with calcified left renal artery an...

    (A) Aortogram with calcified left renal artery aneurysm (RAA). (B-C) Same RAA in magnified view, demonstrating the RAA is saccular, arising from the main renal artery.

More on Renal Artery Aneurysm

Overview: Renal Artery Aneurysm
Workup: Renal Artery Aneurysm
Treatment: Renal Artery Aneurysm
Follow-up: Renal Artery Aneurysm
Multimedia: Renal Artery Aneurysm
References
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Further Reading

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Keywords

aneurysm, renal, renal artery aneurysm (RAA), extraparenchymal aneurysm, saccular aneurysm, fusiform aneurysm, true aneurysm, false aneurysm, dissecting aneurysm, intraparenchymal aneurysm, fibromuscular dysplasia (FMD), blunt abdominal trauma, intraluminal catheter-induced injury, polyarteritis nodosa (PAN), Kawasaki disease, tuberculosis, neurofibromatosis, Ehlers-Danlos syndrome, renal artery injury, stent graft, ex vivo, extracorporeal

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Contributor Information and Disclosures

Author

Wesley K Lew, MD, Resident, Department of General Surgery, University of Southern California
Disclosure: Nothing to disclose.

Coauthor(s)

Fred A Weaver, MD, Professor of Surgery, University of Southern California; Chief, Division of Vascular Surgery, Director of Noninvasive Vascular Laboratory, Program Director of Vascular Surgery, University of Southern California University Hospital;
Fred A Weaver, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Surgery of Trauma, American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Peripheral Vascular Surgery Society, Phi Beta Kappa, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Society of University Surgeons, and Western Surgical Association
Disclosure: CVRx Consulting fee Review panel membership

Christian A Otero, MD, Staff Physician, Department of Surgery, Jackson Memorial Hospital, University of Miami School of Medicine
Disclosure: Nothing to disclose.

Raid Sawaqed, MD, Staff Physician, Department of General Surgery, Catholic Health Partners of Chicago
Raid Sawaqed, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Nicholas D Garcia, MD, Chief of Surgery, Exeter Health Resources; Director, Board of Directors, Core Physician Services; Medical Director, Vascular Lab, Exeter Hospital
Nicholas D Garcia, MD is a member of the following medical societies: American College of Surgeons, New Hampshire Medical Society, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Mark D Morasch, MD, Associate Professor of Surgery, Division of Vascular Surgery, Northwestern University, The Feinberg School of Medicine
Mark D Morasch, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, and Central Surgical Association
Disclosure: W.L. Gore & Associates Honoraria Speaking and teaching; W.L. Gore & Associates Grant/research funds None; Cryolife Honoraria Consulting; King Pharmaceuticals  Honoraria Consulting

Medical Editor

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State College of Medicine
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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