Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Renal Artery Aneurysm Workup

  • Author: Lindsay Gates, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Oct 05, 2015
 

Laboratory Studies

A complete blood count (CBC), chemistry panel, coagulation profile, and urinalysis should be performed prior to any surgical intervention for a renal artery aneurysm (RAA).

Special attention should be paid to the blood urea nitrogen (BUN) and creatinine levels because these values are indicative of renal function and can be followed to confirm that no renal damage exists if the decision is made to manage an RAA nonoperatively.

In a patient with hypertension, RAA, and no renal artery stenosis, studies should be ordered to exclude other endocrine sources of hypertension, including the following:

  • Pheochromocytoma - 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.

Ultrasonography

Ultrasonography (US) with duplex examination is the least invasive imaging study.[38] Two-dimensional (2D) US forms an anatomic picture based on the time delay of ultrasonic pulses reflected from structures. Vessel walls reflect ultrasound waves and appear white; blood absorbs and scatters ultrasound waves, appearing black. Normal vessels appear as dark-filled, white-walled structures.

Duplex studies use Doppler-shift measurement to detect the direction and velocity of blood flow. This can be useful in identifying renal artery stenosis. US can also be used in determining the how functional a kidney is by measuring its size. It should be kept in mind that the quality of imaging is highly operator-dependent and may be limited by the patient's body habitus.

Computed tomography

Computed tomography (CT) is the most widely available and reproducible imaging modality. It is the test of choice for diagnosis and follow-up. Its anatomic resolution is superior to that of US (see the image below).

(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.

The advent of CT angiography (CTA) and three-dimensional (3D) reconstruction has facilitated accurate preinterventional planning. Because intravenous (IV) iodinated dye must be used, the only real limitation of this modality 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 diphenhydramine (histamine-1 receptor antagonist), cimetidine (histamine-2 receptor antagonist), and methylprednisolone sodium succinate (glucocorticoid).

Magnetic resonance angiography

Magnetic resonance angiography (MRA) with gadolinium enhancement and 3D reconstruction can produce images similar in quality to those obtained with arteriography (see the image below). However, this technology is not as readily available as US or CT, and it is more expensive.[39]

Magnetic resonance imaging of a patient with 2 lef 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

Arteriography is the most invasive test but can be useful for helping define unclear anatomy seen on prior examinations (see the images below). For the most part, arteriography as a diagnostic test has been supplanted by CTA 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
 
 
Contributor Information and Disclosures
Author

Lindsay Gates, MD Resident Physician, Integrated Vascular Surgery, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey E Indes, MD, FACS Assistant Professor of Surgery and Radiology, Associate Program Director, Vascular Surgery Residency/Fellowship, Director, Non-Invasive Vascular Laboratory, Director, Yale Vein Center, Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine; Attending Surgeon, Yale-New Haven Hospital and VA Connecticut Healthcare System

Jeffrey E Indes, MD, FACS is a member of the following medical societies: American College of Phlebology, American College of Surgeons, Association for Academic Surgery, Connecticut State Medical Society, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Eastern Vascular Society, Society for Clinical Vascular Surgery, International Society of Endovascular Specialists, Society for Vascular Ultrasound, New England Society for Vascular Surgery, Yale Surgical Society, Association of Program Directors in Vascular Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Travis J Phifer, MD 

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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

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

Disclosure: Nothing to disclose.

Additional Contributors

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, Societe Internationale d'Urologie (International Society of Urology), American Urological Association

Disclosure: Nothing to disclose.

Acknowledgements

Nicholas D Garcia, MD Chief of Surgery, Exeter Hospital; Chair, Board of Directors, 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.

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

Disclosure: Nothing to disclose.

Mark D Morasch, MD Vascular Surgeon, St Vincent's Healthcare Heart and Vascular Center; Professor of Surgery, Division of Vascular Surgery, John Marquardt Clinical Research Professor in 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, American Medical Association, American Venous Forum, Central Surgical Association, Midwest Vascular Society, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Southern Association for Vascular Surgery, WesternSurgicalAssociation, and Western Vascular Surgical Society

Disclosure: W.L. Gore & Associates 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.

Hassan Tehrani, MBBCh  Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine

Disclosure: Nothing to disclose.

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

References
  1. Coleman DM, Stanley JC. Renal artery aneurysms. J Vasc Surg. 2015 Sep. 62 (3):779-85. [Medline].

  2. Down LA, Papavassiliou DV, O'Rear EA. Arterial deformation with renal artery aneurysm as a basis for secondary hypertension. Biorheology. 2013 Jan 1. 50(1):17-31. [Medline].

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

  4. 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].

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

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

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

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

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

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

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

  12. 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. 1997 Jun. 79(6):852-60. [Medline].

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

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

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

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

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

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

  19. 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. 2003 May. 22(5):433-9; quiz 440-2. [Medline].

  20. 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].

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

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

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

  24. 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. 2005 May. 41(5):893-6. [Medline].

  25. Pliskin MJ, Dresner ML, Hassell LH, Gusz JR, Balkin PW, Lerud KS, et al. A giant renal artery aneurysm diagnosed post partum. J Urol. 1990 Dec. 144(6):1459-61. [Medline].

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

  27. 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. 2001 Oct. 58(4):607. [Medline].

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

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

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

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

  32. Zhang LJ, Yang GF, Qi J, Shen W. Renal artery aneurysm: diagnosis and surveillance with multidetector-row computed tomography. Acta Radiol. 2007 Apr. 48(3):274-9. [Medline].

  33. 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. 1995 Feb. 21(2):174-81; discussion 181-3. [Medline].

  34. Buck DB, Curran T, McCallum JC, Darling J, Mamtani R, van Herwaarden JA, et al. Management and outcomes of isolated renal artery aneurysms in the endovascular era. J Vasc Surg. 2015 Sep 17. [Medline].

  35. 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].

  36. Morita K, Seki T, Iwami D, Sasaki H, Fukuzawa N, Nonomura K. Long-term outcome of single institutional experience with conservative and surgical management for renal artery aneurysm. Transplant Proc. 2012 Jul-Aug. 44(6):1795-9. [Medline].

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

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

  39. 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. 2011 Oct 1. 52(8):854-9. [Medline].

  40. Dorigo W, Pulli R, Azas L, Fargion A, Angiletta D, Pratesi G, et al. Early and intermediate results of elective endovascular treatment of true visceral artery aneurysms. Ann Vasc Surg. 2015 Sep 14. [Medline].

  41. Gandini R, Morosetti D, Chiocchi M, Chiaravalloti A, Citraro D, Loreni G, et al. Long-term follow-up of endovascular treatment of renal artery aneurysms with covered stent deployment. J Cardiovasc Surg (Torino). 2014 Dec 5. [Medline].

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

  43. Zhang Z, Yang M, Song L, Tong X, Zou Y. Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas. J Vasc Surg. 2013 Mar. 57(3):765-70. [Medline].

  44. Juszkat R, Zarzecka A, Stanisic M, Majewski W. [Endovascular treatment of the renal artery aneurysm with stent and coils]. Przegl Lek. 2012. 69(7):353-6. [Medline].

  45. 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. 2007 Dec-2008 Jan. 41(6):528-32. [Medline].

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

  47. Rautio R, Haapanen A. Transcatheter embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer. Cardiovasc Intervent Radiol. 2007 Mar-Apr. 30(2):300-3. [Medline].

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

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

  50. Berger L, Palcau L, Gouicem D, Coffin O. Persistent type B aortic dissection treatment by renal artery reentry stent grafting as an alternative to open surgery. Ann Vasc Surg. 2013 May. 27(4):498.e5-8. [Medline].

  51. 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. 2011 Nov 17. [Medline].

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

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

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

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

  56. Tynes WV 2nd. Unusual renovascular disorders. Urol Clin North Am. 1984 Aug. 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 © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.