Pete/Jada

Med-Surge 201
Pathophysiology on Renal Artery Aneurysm

Renal Artery Aneurysm:

A renal artery aneurysm is a dilated segment of the renal artery that exceeds twice the diameter
of a normal renal artery. These types of aneurysms are rare; the incidence is about .7 percent.
Overall, the average age for patients to present with renal artery aneurysms is between ages 40
and 60. One explanation can be atherosclerosis (sometimes called hardening or clogging of the
arteries. But, normally it is more common in women than men because of the increased
prevalence of fibromuscular dysplasia among females.
There are two kinds of renal artery aneurysms: true and false. Ninety percent of these cases are
true, which means all layers of the blood vessel wall are present in the aneurysm, and 10 percent
are false (all layers are not present and the aneurysm is possibly being contained by fibrous or
inflammatory tissue). False aneurysms are usually caused by trauma or because of a medical
treatment or procedure.

Renal Artery Aneurysm Symptoms:

Most renal artery aneurysms do not produce symptoms and found incidentally on other
abdominal imaging. Sometimes, this kind of aneurysm can rupture or cause hypertension, pain,
and/or hematuria (blood in the urine). The most dreaded complication is rupture which could
lead to mortality. Rupture in pregnant women has a maternal mortality rate of 55 percent, and a
fetal death rate of 85 percent.

Renal Artery Aneurysm Treatments:

The medical team may recommend surgery to treat the renal artery aneurysm if it ruptures;
causes pain, a blood clot, or hematuria; or is a recently diagnosed false aneurysm. Additionally,
surgical treatment may be prescribed for pregnant women or women of child bearing age and
people with aneurysms larger than two cm in diameter.
Splenic artery aneurysm surgical treatment options include:
 Open Surgical Repair: There are various open surgeries that are available to treat renal
artery aneurysms. A lot of the decision making as to which technique to use depends on
the kind of the aneurysm and its relation and location to the main branches of the renal
artery and the kidney. The most straightforward involves suturing with primary or patch
closure. Patients with complex cases may require bypass using a vein in the leg or
extraction of the kidney to repair the aneurysm followed by reinsertion of the kidney.
Some patients may require total or partial nephrectomy because the anatomy may not be
amenable to repair techniques. These operations are challenging, but, when performed by
trained surgeons, the risk of complications is low. There is an extended length of stay and
recovery time as compared to endovascular techniques.

Endovascular Techniques: Endovascular techniques for repairing renal artery

aneurysms are relatively new, but these have had optimal outcomes. The surgeon may
recommend endovascular surgery, depending on the anatomy and location of the
aneurysm. One endovascular treatment uses coil embolization (thin platinum or steel
wires with retained memory that allows them to spiral once deployed from a catheter).
Liquid embolization is another emerging technique. There has also been good experience
using coated stent grafts for treatment as the technology has advanced. These procedures
can be performed from the wrist or the groin with minimal complications and very short
hospitalization and recovery times. Long-term results are unclear, so these patients
require periodic surveillance for life.

Outcome and prognosis are very good with elective repair. The prognosis after rupture of a renal
artery aneurysm has also improved with advancements in care.