Renal Artery Aneurysm Workup

  • Author: Wesley K Lew; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Nov 22, 2011
 

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
Next

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.[32] 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, as depicted in the image below. 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 o(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, as depicted in the image below. However, this technology is not as readily available as US or CT and is a more expensive test.[33] Magnetic resonance imaging of a patient with 2 lefMagnetic 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, as depicted in the images below. For the most part, arteriography as a diagnostic test has been supplanted by CT angiography and MRA. (A) Aortogram with calcified left renal artery ane(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. (A) Computed tomography scan and (B) arteriogram o(A) Computed tomography scan and (B) arteriogram of the same patient with a saccular left renal artery aneurysm at a segmental renal artery branch.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Wesley K Lew  MD, Fellow, Department of Vascular Surgery, University of California, Los Angeles

Disclosure: Nothing to disclose.

Coauthor(s)

Fred A Weaver, MD, MMM  Professor of Surgery, Chief, Division of Vascular Surgery and Endovascular Therapy, Co-Director USC CardioVascular Thoracic Institute; Keck School of Medicine, University of Southern California

Fred A Weaver, MD, MMM 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 Hospital; Director, Board of Directors, Core Physician Services; Associate Medical Director, Core Physicians, LLC

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  Professor of Surgery, Division of Vascular Surgery, John Marquardt Clinical Research Professor in Vascular Surgery, Northwestern University, Feinberg School of Medicine

Mark D Morasch, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Medical Association, American Venous Forum, Central Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Surgical Association

Disclosure: W.L. Gore & Associates Honoraria Speaking and teaching; W.L. Gore & Associates Grant/research funds None; King Pharmaceuticals Honoraria Consulting

Specialty Editor Board

Richard A Santucci, MD, FACS  Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

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: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Hassan Tehrani, MB, BCh, to the development and writing of this article.

References

  1. Rouppe DL. Nova Acta Phys-Med Acad Nat Curios. 1770;iv:76.

  2. Baandrup U, Fjeldborg O, Olsen S. Spontaneous dissecting aneurysm of the renal arteries. A case and a review of the literature. Virchows Arch A Pathol Anat Histopathol. 1983;402(1):73-82. [Medline].

  3. Bulbul MA, Farrow GA. Renal artery aneurysms. Urology. Aug 1992;40(2):124-6. [Medline].

  4. Cohen JR, Shamash FS. Ruptured renal artery aneurysms during pregnancy. J Vasc Surg. Jul 1987;6(1):51-9. [Medline].

  5. Dean RH, Meacham PW, Weaver FA. Ex vivo renal artery reconstructions: indications and techniques. J Vasc Surg. Dec 1986;4(6):546-52. [Medline].

  6. Dzsinich C, Gloviczki P, McKusick MA, et al. Surgical management of renal artery aneurysm. Cardiovasc Surg. Jun 1993;1(3):243-7. [Medline].

  7. Gewertz BL, Stanley JC, Fry WJ. Renal artery dissections. Arch Surg. Apr 1977;112(4):409-14. [Medline].

  8. Hidai H, Kinoshita Y, Murayama T, et al. Rupture of renal artery aneurysm. Eur Urol. 1985;11(4):249-53. [Medline].

  9. Hubert JP Jr, Pairolero PC, Kazmier FJ. Solitary renal artery aneurysm. Surgery. Oct 1980;88(4):557-65. [Medline].

  10. Klein GE, Szolar DH, Breinl E, et al. Endovascular treatment of renal artery aneurysms with conventional non- detachable microcoils and Guglielmi detachable coils. Br J Urol. Jun 1997;79(6):852-60. [Medline].

  11. Lumsden AB, Salam TA, Walton KG. Renal artery aneurysm: a report of 28 cases. Cardiovasc Surg. Apr 1996;4(2):185-9. [Medline].

  12. Martin RS 3rd, Meacham PW, Ditesheim JA, et al. Renal artery aneurysm: selective treatment for hypertension and prevention of rupture. J Vasc Surg. Jan 1989;9(1):26-34. [Medline].

  13. Ortenberg J, Novick AC, Straffon RA, et al. Surgical treatment of renal artery aneurysms. Br J Urol. Aug 1983;55(4):341-6. [Medline].

  14. Seki T, Koyanagi T, Togashi M, et al. Experience with revascularizing renal artery aneurysms: is it feasible, safe and worth attempting?. J Urol. Aug 1997;158(2):357-62. [Medline].

  15. Stanley JC, Rhodes EL, Gewertz BL, et al. Renal artery aneurysms. Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations. Arch Surg. Nov 1975;110(11):1327-33. [Medline].

  16. Seppala FE, Levey J. Renal artery aneurysm: case report of a ruptured calcified renal artery aneurysm. Am Surg. Jan 1982;48(1):42-4. [Medline].

  17. Tham G, Ekelund L, Herrlin K, et al. Renal artery aneurysms. Natural history and prognosis. Ann Surg. Mar 1983;197(3):348-52. [Medline].

  18. Sicard GA, Reilly JM, Rubin BG, et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial. J Vasc Surg. Feb 1995;21(2):174-81; discussion 181-3. [Medline].

  19. Witz M, Lehmann JM. Aneurysmal arterial disease in a patient with Ehlers-Danlos syndrome. Case report and literature review. J Cardiovasc Surg (Torino). Apr 1997;38(2):161-3. [Medline].

  20. Ohebshalom MM, Tash JA, Coll D, et al. Massive hematuria due to right renal artery mycotic pseudoaneurysm in a patient with subacute bacterial endocarditis. Urology. Oct 2001;58(4):607. [Medline].

  21. Yacoe ME, Dake MD. Development and resolution of systemic and coronary artery aneurysms in Kawasaki disease. AJR Am J Roentgenol. Oct 1992;159(4):708-10. [Medline].

  22. Smith JN, Hinman F Jr. Intrarenal arterial aneurysms. J Urol. Jun 1967;97(6):990-6. [Medline].

  23. Poutasse EF. Renal artery aneurysms. J Urol. Apr 1975;113(4):443-9. [Medline].

  24. Mattar SG, Kumar AG, Lumsden AB. Vascular complications in Ehlers-Danlos syndrome. Am Surg. Nov 1994;60(11):827-31. [Medline].

  25. Calligaro KD, Dougherty MJ. Renal artery aneurysms and arteriovenous fistulae. In: Rutherford RB, ed. Vascular Surgery. 5th ed. Philadelphia, Pa: WB Saunders; 2000:1697-702.

  26. Callicutt CS, Rush B, Eubanks T, et al. Idiopathic renal artery and infrarenal aortic aneurysms in a 6-year-old child: case report and literature review. J Vasc Surg. May 2005;41(5):893-6. [Medline].

  27. Henriksson C, Bjorkerud S, Nilson AE, et al. Natural history of renal artery aneurysm elucidated by repeated angiography and pathoanatomical studies. Eur Urol. 1985;11(4):244-8. [Medline].

  28. Youkey JR, Collins GJ Jr, Orecchia PM, et al. Saccular renal artery aneurysm as a cause of hypertension. Surgery. Apr 1985;97(4):498-501. [Medline].

  29. Bastounis E, Pikoulis E, Georgopoulos S, et al. Surgery for renal artery aneurysms: a combined series of two large centers. Eur Urol. 1998;33(1):22-7. [Medline].

  30. Stephens, FD. Smith, ED, Hutson, JM. Ureterovascular hydronephrosis and the aberrant renal vessels. In: Congenital Anomalies of the Kidney, Urinary and Genital Tracts. 2nd. New York, New York: Informa Health Care; 2002:275-80.

  31. Aytac SK, Yigit H, Sancak T, et al. Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation. J Ultrasound Med. May 2003;22(5):433-9; quiz 440-2. [Medline].

  32. Low G, Winters SD, Owen RJ. Surveillance of a coiled renal artery aneurysm by contrast-enhanced ultrasound with Definity. J Vasc Surg. Sep 2 2011;[Medline].

  33. Seo JM, Park KB, Kim KH, Jeon P, Shin SW, Park HS, et al. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography. Acta Radiol. Oct 1 2011;52(8):854-9. [Medline].

  34. Love WK, Robinette MA, Vernon CP. Renal artery aneurysm rupture in pregnancy. J Urol. Dec 1981;126(6):809-11. [Medline].

  35. Clark TW, Sankin A, Becske T, et al. Stent-assisted Gugliemi detachable coil repair of wide-necked renal artery aneurysm using 3-D angiography. Vasc Endovascular Surg. Dec-2008 Jan 2007;41(6):528-32. [Medline].

  36. Dulabon LM, Singh A, Vogel F, et al. Intrarenal pseudoaneurysm presenting with microscopic hematuria and right flank pain. Can J Urol. Jun 2007;14(3):3588-91. [Medline].

  37. Moyer HR, Hiramoto JS, Wilson MW, et al. Stent-graft repair of a splenic artery aneurysm. J Vasc Surg. May 2005;41(5):897. [Medline].

  38. Bui BT, Oliva VL, Leclerc G, et al. Renal artery aneurysm: treatment with percutaneous placement of a stent-graft. Radiology. Apr 1995;195(1):181-2. [Medline].

  39. Iezzi R, Santoro M, Di Natale G, Pirro F, Dattesi R, Nestola M, et al. Aortic-neck dilation after endovascular abdominal aortic aneurysm repair (EVAR): can it be predicted?. Radiol Med. Nov 17 2011;[Medline].

  40. English WP, Pearce JD, Craven TE, et al. Surgical management of renal artery aneurysms. J Vasc Surg. Jul 2004;40(1):53-60. [Medline].

  41. Lauzurica R, Borras M, Bonet J, et al. Hypertension and renal artery aneurysm: spontaneous cure. J Urol. Dec 1989;142(6):1556-7. [Medline].

  42. Sorcini A, Libertino JA. Vascular reconstruction in urology. Urol Clin North Am. Feb 1999;26(1):219-34, x-xi. [Medline].

  43. Szilagyi DE, Hageman JH, Smith RF, et al. Spinal cord damage in surgery of the abdominal aorta. Surgery. Jan 1978;83(1):38-56. [Medline].

  44. Tynes WV 2nd. Unusual renovascular disorders. Urol Clin North Am. Aug 1984;11(3):529-42. [Medline].

 
Previous
Next
 
Schematic of renal artery anatomy. The aneurysm location can be classified as extraparenchymal or intraparenchymal.
(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.
(A) Computed tomography scan and (B) arteriogram of the same patient with a saccular left renal artery aneurysm at a segmental renal artery branch.
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.
(A) Extraparenchymal saccular aneurysm. (B) Tangential excision with patch angioplasty.
(A) Fibromuscular dysplasia with string-of-beads appearance and wide-necked extraparenchymal saccular aneurysm. (B) Aneurysm excision with reconstruction using a bypass graft.
Arteriogram of saccular renal artery aneurysm after coil embolization.
Subsequent expansion of aneurysm 6 months after coil embolization.
(A) Renal artery stenosis with poststenotic fusiform aneurysm. (B) Exclusion of aneurysm and dilatation of stenosis with endovascular stent graft.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.