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Choksi H, Singla A, Yoon P, Pang T, Vicaretti M, Yao J, Lee T, Yuen L, Laurence J, Lau H, Pleass H. Outcomes of endovascular, open surgical and autotransplantation techniques for renal artery aneurysm repair: a systematic review and meta-analysis. ANZ J Surg 2023; 93:2303-2313. [PMID: 37522385 DOI: 10.1111/ans.18628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Renal artery aneurysms (RAA) can be repaired with endovascular exclusion (EVR), open repair (OR), or ex-vivo repair with renal autotransplantation (ERAT). This systematic review compares repair indications, aneurysm characteristics, and complications following these interventions. METHODS A systematic review of databases including MEDLINE, PUBMED, and EMBASE by two independent reviewers for studies from January 2000-November 2022. All studies evaluating repair indications, RAA morphology, morbidity and mortality following EVR, OR, and ERAT were included. RESULTS A total of 38 studies were included with 1540 EVR, 2377 OR and 109 ERAT subjects. Increasing aneurysm size, or diameters >20 mm, were the most common repair indications across EVR and OR (n = 537; 48%), and ERAT (n = 23; 52%). All ERAT repairs were at or distal to renal artery bifurcations (n = 46). Meta-analyses demonstrated significantly shorter length of stay (LOS) with EVR compared to OR (mean difference -4.06, 95% confidence interval (CI) -5.69 to -2.43, P < 0.001). No significant differences were found in mean aneurysm diameter (P = 0.23), total complications (P = 0.17), and mortality (P = 0.85). Major complications (Clavien-Dindo ≥III) across studies most commonly included acute renal failure (EVR 4.9% vs. OR 7.0%). Nephrectomy was the most common major complication in ERAT (5.5%). CONCLUSIONS Outcomes following EVR and OR of RAAs are comparable. EVR offers a shorter LOS, with no difference in morbidity or mortality. ERAT is currently only utilized for distal RAAs, however carries higher risk of infarction and nephrectomy necessitating specialized expertise or algorithms to assist appropriate selection of repair methods.
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Affiliation(s)
- Harsham Choksi
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Animesh Singla
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Peter Yoon
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Tony Pang
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Mauro Vicaretti
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jinna Yao
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Taina Lee
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jerome Laurence
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Howard Lau
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Henry Pleass
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
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Porcaro P, Turchino D, Quarantelli M, Guercio LD, Accarino G, Serra R, Venetucci P, Bracale UM. Endovascular treatment of a wide-necked renal artery aneurysm with a flow diverter stent. Radiol Case Rep 2023; 18:2854-2859. [PMID: 37388268 PMCID: PMC10300470 DOI: 10.1016/j.radcr.2023.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
Renal artery aneurysm (RAA) is a rare, often asymptomatic disease (0.1% incidence in general population) and can be incidentally diagnosed during an abdominal imaging workup. The traditional, gold standard of treatment is open surgery, carrying with it, however, a high risk of nephrectomy, mortality, and collateral morbidity. The endovascular approach is currently the most valid alternative to treating RAAs reducing, as it does, the risks associated with the surgical approach/open surgery. Herein we report on our experience with a case of wide-necked RAA treated with the Pipeline Vantage (Medtronic) flow diverter stent. Wide-neck aneurysms are defined as having neck diameters greater than 4 mm. Our choice of endovascular treatment was preferred over the surgical option notwithstanding the large size of the neck and the involvement of the branching vessels.
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Affiliation(s)
| | - Davide Turchino
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Mario Quarantelli
- Department of Radiology, University Federico II of Naples, Naples, Italy
| | - Luca del Guercio
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Giulio Accarino
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Raffaele Serra
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pietro Venetucci
- Department of Radiology, University Federico II of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
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Ghosh S, Dutta SK. Endovascular interventions in management of renal artery aneurysm. Br J Radiol 2021; 94:20201151. [PMID: 34111371 DOI: 10.1259/bjr.20201151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal artery aneurysm (RAA) is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females for in which case patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization (SACE), balloon-assisted coil embolization (BACE), selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-hystroacril and onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization has been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.
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Affiliation(s)
- Sandipan Ghosh
- Department of Intensive Coronary Care Unit, B.P.Poddar Hospital and Medical Research Ltd. 71/1, Humayun Kabir Sarani, Block - G, New Alipore, Kolkata, India
| | - Soumya Kanti Dutta
- Department of Interventional Cardiology, B.P.Poddar Hospital and Medical Research Ltd. 71/1, Humayun Kabir Sarani, Block - G, New Alipore, Kolkata, India
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Meadors S, Modrall JG, Timaran CH, Malekpour F. Case Report of a Renal Artery Aneurysm Due to IgG4-Related Disease. Ann Vasc Surg 2021; 73:515-520. [PMID: 33503500 DOI: 10.1016/j.avsg.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
We report a 5.8 cm left renal artery aneurysm in a 71-year-old male with IgG4-related disease. To our knowledge, this is the first reported renal artery aneurysm associated with this condition. After being considered for nephrectomy, the patient underwent ex vivo left renal artery aneurysm repair to preserve renal function and remains dialysis-free at 2 years of follow-up.
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Affiliation(s)
- Steven Meadors
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - J Gregory Modrall
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Section of Vascular Surgery, Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Fatemeh Malekpour
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Secco G, Chevallier O, Falvo N, Guillen K, Comby PO, Mousson C, Majbri N, Midulla M, Loffroy R. Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes. J Clin Med 2021; 10:326. [PMID: 33477284 PMCID: PMC7830953 DOI: 10.3390/jcm10020326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/01/2023] Open
Abstract
The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010-2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.
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Affiliation(s)
- Grégory Secco
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (G.S.); (O.C.); (N.F.); (K.G.); (M.M.)
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (G.S.); (O.C.); (N.F.); (K.G.); (M.M.)
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (G.S.); (O.C.); (N.F.); (K.G.); (M.M.)
| | - Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (G.S.); (O.C.); (N.F.); (K.G.); (M.M.)
| | - Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France;
| | - Christiane Mousson
- Department of Nephrology and Renal Transplantation, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (C.M.); (N.M.)
| | - Nabil Majbri
- Department of Nephrology and Renal Transplantation, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (C.M.); (N.M.)
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (G.S.); (O.C.); (N.F.); (K.G.); (M.M.)
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (G.S.); (O.C.); (N.F.); (K.G.); (M.M.)
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Ma T, He Y, Zhong W, Luo G, Li Q, Wang Z, Zhang H, Wu Z, Qiu C. Mid-term Results of Coil Embolization Alone and Stent-assisted Coil Embolization for Renal Artery Aneurysms. Ann Vasc Surg 2020; 73:296-302. [PMID: 33387622 DOI: 10.1016/j.avsg.2020.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coil embolization (CE) alone and stent-assisted coil embolization (SCE) are two major endovascular techniques to treat renal artery aneurysms (RAAs). This study aimed at providing safety and efficacy data of CE and SCE for RAAs. METHODS Between August 2015 and June 2019, 40 RAA patients treated with CE or SCE were included in the retrospective study. Patients' demographics, clinical manifestations, aneurysm characteristics, treatment strategies, and follow-up results were collected and analyzed. RESULTS There were 26 and 14 patients in the CE and SCE group, respectively. The mean aneurysm diameter was 2.5 ± 1.5 cm and 2.2 ± 0.8 cm (CE versus SCE, P = 0.52). The neck width of the aneurysm was 0.63 ± 0.37 cm and 1.07 ± 0.42 cm (CE versus SCE, P = 0.021). Technical success was achieved in 97.5% patients. No death or aneurysm rupture occurred. During the perioperative period, 12% and 7.1% patients suffered partial renal infarction (CE versus SCE, P = 0.45). The mean duration of follow-up was 8.8 ± 9.4 months and 16.1 ± 16.3 months (CE versus SCE, P = 0.158) by imaging and 20.8 ± 11.3 and 22.7 ± 16.5 months by visit/telephone (CE versus SCE, P = 0.703). During the follow-up, 17.4% patients in the CE group and 30.8% patients in the SCE group suffered partial renal infarction, while their overall renal function remained normal. In addition, there was no aneurysm recurrence, sac enlargement, or death in both groups. CONCLUSIONS Both CE and SCE were safe and effective to treat RAAs. In addition, SCE may prevent coil migration in the wide neck aneurysm in selected patients.
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Affiliation(s)
- Tianfeng Ma
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wen Zhong
- Department of Clinical Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Geng Luo
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qiang Li
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhize Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 315] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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Goto T, Shimohira M, Ohta K, Suzuki K, Sawada Y, Shibamoto Y. Combination of the double-microcatheter technique and triaxial system in coil packing for visceral and renal artery aneurysms. Acta Radiol 2019; 60:1057-1062. [PMID: 30396286 DOI: 10.1177/0284185118810983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background In coil packing for visceral artery aneurysms (VAAs), difficulties are sometimes associated with preserving the patency of the parent artery, particularly for wide-neck aneurysms. However, the double-microcatheter technique effectively prevents coil migration, while the triple-coaxial (triaxial) system is useful for reducing microcatheter kick-back. Purpose To assess the feasibility of combining these two techniques in coil packing for VAAs. Material and Methods Coil packing using the double-microcatheter technique and triaxial system was attempted for seven VAAs in six patients between August 2015 and January 2018. The technical success rate, packing density of aneurysms, complications related to the procedure, and occlusion status were evaluated. Technical success was defined as the completion of coil packing by immediate post-embolic angiography. The occlusion status was evaluated using time-resolved magnetic resonance angiography. Results There were three renal, three splenic, and one anterior superior pancreaticoduodenal aneurysms. The median size of VAAs was 13 mm (range = 8–21 mm), with five being classified as wide-neck aneurysms. The completion of coil packing was confirmed for all VAAs and the technical success rate was 100%. The median packing density was 28% (range = 22–40%). There were no complications related to the procedure. The median follow-up period was 14 months (range = 8–24 months). In six VAAs that were followed up, there were three complete occlusions, three neck remnants, and no body filling; re-treatment was not required in any patient. Conclusion The combination of the double-microcatheter technique and triaxial system is a feasible method of coil packing for VAAs.
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Affiliation(s)
- Taeko Goto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazushi Suzuki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Murray TÉ, Brennan P, Maingard JT, Chandra RV, Little DM, Brooks DM, Kok HK, Asadi H, Lee MJ. Treatment of Visceral Artery Aneurysms Using Novel Neurointerventional Devices and Techniques. J Vasc Interv Radiol 2019; 30:1407-1417. [PMID: 31036460 DOI: 10.1016/j.jvir.2018.12.733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/30/2018] [Accepted: 12/30/2018] [Indexed: 10/26/2022] Open
Abstract
The presence of branching vessels, a wide aneurysm neck, and/or fusiform morphology represents a challenge to conventional endovascular treatment of visceral artery aneurysms. A variety of techniques and devices have emerged for the treatment of intracranial aneurysms, in which more aggressive treatment algorithms aimed at smaller and morphologically diverse aneurysms have driven innovation. Here, modified neurointerventional techniques including the use of compliant balloons, scaffold- or stent-assisted coil embolization, and flow diversion are described in the treatment of visceral aneurysms. Neurointerventional devices and their mechanisms of action are described in the context of their application in the peripheral arterial system.
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Affiliation(s)
- Timothy Éanna Murray
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland.
| | - Paul Brennan
- Department of Interventional Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Julian T Maingard
- Department of Interventional Radiology and Interventional Neuroradiology Unit, Austin Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia
| | - Dilly M Little
- Department of Urology and Transplant Surgery, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - D Mark Brooks
- Department of Interventional Radiology and Interventional Neuroradiology Unit, Austin Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Hong K Kok
- Interventional Radiology Service, Northern Hospital Radiology, Melbourne, Australia
| | - Hamed Asadi
- Department of Interventional Radiology and Interventional Neuroradiology Unit, Austin Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia
| | - Michael J Lee
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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Eldem G, Erdoğan E, Peynircioğlu B, Arat A, Balkancı F. Endovascular treatment of true renal artery aneurysms: a single center experience. ACTA ACUST UNITED AC 2019; 25:62-70. [PMID: 30272561 DOI: 10.5152/dir.2018.17354] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE We aimed to report a single center's experience on endovascular treatment of true renal artery aneurysms (TRAAs), including treatment techniques and outcomes. METHODS This retrospective study was designed to evaluate the treatment and follow-up of TRAAs treated by a variety of endovascular interventional techniques over a period of 6 years. Six patients with nine TRAAs were identified; seven of the TRAAs were treated using different combinations of coil embolization and flow diverter stents. The clinical findings, aneurysm characteristics, endovascular methods and treatment outcomes were reported. RESULTS Seven TRAAs of six patients were treated, with a median aneurysm size of 20 mm. Three TRAAs were treated with primary sac occlusion (one with primary coil embolization, one with balloon and stent assisted coil and glue embolization, and one with amplatzer vascular occlusion device and coil embolization). The remaining four TRAAs of three patients were treated with flow diverter stents (Cardiatis, Silk, Pipeline, and Surpass). Immediate clinical success was achieved in patients treated with primary sac embolization (95% CI, 29.2%-100%). Among patients treated with flow diverter stents, one patient required an additional flow diverter at 6-month follow-up. The occlusion time in flow diverters ranged from 1 month to 12 months (median, 3.5 months) taking the repeat procedure into account. In patients treated with flow diverters, the clinical success rate was 100% (95% CI, 29.2%-100%) at one-year follow-up. Long-term follow-up ranged from 3 to 52 months. One intraprocedural complication was encountered with a flow diverter during deployment, which required additional stenting and tirofiban infusion. No other major complication was seen. CONCLUSION Endovascular treatment is an effective and safe method offering high success rates and low morbidity in the treatment of TRAAs and may supplant surgery as the primary therapy. Current experience in the use of flow diverter stents in TRAAs is limited to individual case reports with one brand of flow diverter device. Our small numbered series of four TRAAs shows our experience regarding endovascular treatment with different flow diverter brands.
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Affiliation(s)
- Gonca Eldem
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Erhan Erdoğan
- Department of Radiology, Eskisehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Bora Peynircioğlu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Anıl Arat
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ferhun Balkancı
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Endovascular Treatment of Ruptured Renal Artery Aneurysm: A Case-Based Literature Review. Case Rep Med 2019; 2019:3738910. [PMID: 30881459 PMCID: PMC6381552 DOI: 10.1155/2019/3738910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/16/2018] [Accepted: 01/20/2019] [Indexed: 11/18/2022] Open
Abstract
Renal artery aneurysms are extremely uncommon with a reported incidence of less than one percent in general population. They are being more frequently detected due to increasing availability and use of abdominal imaging. Renal artery aneurysm rupture is an extremely unusual cause of acute flank pain with hemodynamic instability. Given the rarity of diagnoses, clinicians may not consider and address this ruptured renal artery aneurysm early which can potentially lead to adverse clinical outcomes. We report the case of a 55-year-old male who presented with retroperitoneal bleeding from a ruptured aneurysm of the interlobular branch of renal artery. He was endovascularly treated with coil embolization. We have also reviewed the inherent literature.
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12
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Preliminary Results of Stent-Assisted Coiling of Wide-Necked Visceral Artery Aneurysms via Self-Expandable Neurointerventional Stents. J Vasc Interv Radiol 2019; 30:49-53. [DOI: 10.1016/j.jvir.2018.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
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13
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Rodriguez-Rapale VA, Martinez-Trabal JL. Hilar Renal Artery Aneurysm Repair Using Coil Embolization and Covered Stent. Vasc Endovascular Surg 2018; 53:82-85. [PMID: 30180784 DOI: 10.1177/1538574418798113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION: Little has been reported regarding endovascular therapy with stent of renal artery hilar aneurysms. To that end, we herein report the outcomes of 3 hilar renal artery aneurysms (RAA) treated with an endovascular technique that makes use of a covered stent and coil embolization in the repair of hilar RAA and deem using this technique is better than traditional open approach with back-table repair and autotransplatation. METHODS: Since November 2014, 3 consecutive patients have been referred to the vascular surgery service for evaluation of a right RAA; these patients' aneurysms were diagnosed with a CT arteriogram prior to evaluation. These patients, typically treated with open surgery, were deemed to be candidates for endovascular repair and were treated as follows: (1) cannulation of the right Common Femoral Artery with a selective arteriogram of the right renal artery, (2) covered stent to dominant hilar artery branch, and (3) coil embolization of the remaining branches/tributaries. Perioperative outcomes and quality measures were analyzed and compared. RESULTS: The aneurysms were successfully covered and excluded as confirmed by a completion arteriogram. There were no perioperative morbidities (ie, acute kidney injury, endoleak, etc), and all 3 patients were discharged home the same days of their interventions. At their follow-up visits, the patients were free of symptoms and had normal renal functions as well as Computed tomography angiography (CTA) confirming successfully excluded aneurysms and no endoleaks. CONCLUSION: The technique we used demonstrated excellent outcomes with minimal comorbidities and preservation of renal function. As with many endovascular interventions, our technique compared favorably to traditional open technique in terms of technical feasibility, decreased length of stay, faster recovery, maintaining renal function, and reduced complication rates.
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Affiliation(s)
- Victor A Rodriguez-Rapale
- 1 Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce Health Sciences University, Ponce, PR, USA
| | - Jorge L Martinez-Trabal
- 1 Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce Health Sciences University, Ponce, PR, USA
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Wei X, Sun Y, Wu Y, Li Z, Zhu J, Zhao Z, Feng R, Jing Z. Management of wide-based renal artery aneurysms using noncovered stent-assisted coil embolization. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Maingard J, Kok HK, Phelan E, Logan C, Ranatunga D, Brooks DM, Chandra RV, Lee MJ, Asadi H. Endovascular Treatment of Wide-Necked Visceral Artery Aneurysms Using the Neurovascular Comaneci Neck-Bridging Device: A Technical Report. Cardiovasc Intervent Radiol 2017; 40:1784-1791. [DOI: 10.1007/s00270-017-1733-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/23/2017] [Indexed: 01/02/2023]
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Editor's Choice - Ex vivo Renal Artery Repair with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Long-term Results of Sixty-seven Procedures. Eur J Vasc Endovasc Surg 2016; 51:872-9. [PMID: 27036374 DOI: 10.1016/j.ejvs.2016.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/23/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND To evaluate the long-term outcome of renal revascularization by ex vivo renal artery reconstruction and autotransplantation for renal artery branch aneurysms (RABAs). METHODS Between 1991 and 2015, 67 ex vivo renal artery reconstructions with kidney autotransplantation were performed in 55 adults (mean age 47 years) and 10 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia in 34 patients. Other etiologies were systemic congenital disease in eight patients, spontaneous dissecting aneurysms in five, iatrogenic aneurysms in three, atheromatous aneurysms in two and unknown etiology in 13. Median RABA diameter was 20.5 mm. Fifty-three patients (82%) were hypertensive, 60 had normal renal function and no patient was on hemodialysis. Seven patients (11%) were operated on after failure of an endovascular procedure. The mean number of renal artery branches repaired per patient was 3.5 and multiple aneurysms were treated in 14 patients (22%). The hypogastric artery was used in 41 patients, the saphenous vein in 18, the superficial femoral artery in five and a combination of different materials in three. RESULTS No deaths occurred during the first 30 days. Primary patency at 30 days was 90.8% following to six early thromboses. Three patients (5%) were lost to follow up. No other thrombosis occurred. At 8 years, the primary and primary-assisted patency were 88% and 91%, respectively. Survival was 95% at 9 years. Among the 53 hypertensive patients, two were lost to follow up. At 9 years, 22 (43%) were cured and nine (18%) were improved with a significant reduction of antihypertensive medication (p < .05). The pre-operative modification of the diet in renal disease (MDRD) clearance was 93 ± 29 mL/minute, the immediate post-operative MDRD was 94 ± 33 mL/minute, and at the end of follow up it was 86 ± 26 mL/minute (p > .05). CONCLUSION Ex vivo renal artery reconstruction for complex RABAs eliminates the risk of rupture, confers a benefit to hypertension, and preserves renal function with a satisfactory long-term patency.
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Loffroy R, Favelier S, Pottecher P, Genson PY, Estivalet L, Gehin S, Cercueil JP, Krausé D. Endovascular management of visceral artery aneurysms: When to watch, when to intervene? World J Radiol 2015; 7:143-148. [PMID: 26217453 PMCID: PMC4506932 DOI: 10.4329/wjr.v7.i7.143] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/17/2015] [Accepted: 05/05/2015] [Indexed: 02/06/2023] Open
Abstract
Visceral artery aneurysms (VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms (VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the first-line therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.
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Abstract
Renal artery aneurysm (RAA) is an uncommon disease and is typically an incidental finding on imaging performed for other medical ailments. Sequelae of RAA include rupture and difficult to control hypertension. Repair of RAA is considered in suitable surgical candidates when a maximum diameter of 2 cm is reached or in those females who are pregnant or trying to conceive. Surgical options have expanded from traditional open aneurysmectomy or arteriorrhaphy to robotic-laparoscopic repair and a manifold of endovascular approaches.
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Affiliation(s)
- Kristine C Orion
- Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Halsted 668, 600 N. Wolfe Street, Baltimore, MD 21287-8611
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Halsted 668, 600 N. Wolfe Street, Baltimore, MD 21287-8611.
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Almeida-Lopes J, Brandão D, Mansilha A. Técnica de embolização assistida por stent de aneurisma da artéria renal. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/s1646-706x(14)70054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Buso R, Rattazzi M, Leoni M, Puato M, Paola FD, Pauletto P. An Unusual Case of Fibromuscular Dysplasia with Bilateral Renal Macroaneurysms: Three-year Outcome After Endovascular Treatment. Open Cardiovasc Med J 2013; 7:50-3. [PMID: 24044026 PMCID: PMC3772574 DOI: 10.2174/1874192401307010050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/22/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-inflammatory and non-atherosclerotic disease
that affects arterial walls, leading to stenosis of small and medium-sized arteries. FMD mostly involves renal and intracranial
arteries and only in few patients is associated with macroaneurysms (RAAs). We present the case of a 45-years old
woman with recent history of grade 2 hypertension that suffered of subarachnoid haemorrhage due to rupture of a basilar
artery aneurysm. The cerebral aneurysm was immediately treated by coil embolization and an abdominal angio-CT scan
was performed to investigate the presence of renovascular hypertension. The exam showed the presence of FMD of the
renal arteries associated with presence of bilateral RAAs. Due to the high risk of rupture, the bigger aneurysm (2,5 cm diameter)
present on the left artery was immediately treated by coil embolization. The fusiform aneurysm, present on the
right renal artery, was instead treated one year later by using two flow diverter stents. After three years, an angiographic
study showed that both cerebral and renal aneurysms were excluded from the blood flow without evidence of arterial
restenosis.
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Affiliation(s)
- Roberta Buso
- Department of Medicine, University of Padova, Italy ; Medicina Interna I^, Ca' Foncello Hospital, Azienda ULSS 9, Treviso, Italy
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Zhang Z, Yang M, Song L, Tong X, Zou Y. Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas. J Vasc Surg 2013; 57:765-70. [DOI: 10.1016/j.jvs.2012.09.042] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 07/25/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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Endovascular treatment of renal aneurysms: A series of 18 cases. Eur J Radiol 2012; 81:3973-8. [DOI: 10.1016/j.ejrad.2012.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022]
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Ferrara SL, Kinney TB, Hall LD. Endovascular treatment of a congenital thoracic aortic aneurysm in a premature newborn. J Vasc Interv Radiol 2012; 23:1330-4. [PMID: 22999752 DOI: 10.1016/j.jvir.2012.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/29/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022] Open
Abstract
Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.6-kg male was delivered expeditiously by Cesarean section at 35(2)/(7) weeks' gestation. On day of life 1, bilateral femoral arterial access was used to deliver a balloon-expandable stent across the wide-necked aneurysm. Microcoil embolization of the aneurysm via a prepositioned microcatheter was then performed. The child had an uncomplicated hospital course and is asymptomatic 5 months later, with complete aneurysm thrombosis.
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MESH Headings
- Aortic Aneurysm, Thoracic/congenital
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/therapy
- Aortography/methods
- Cesarean Section
- Embolization, Therapeutic
- Endovascular Procedures/instrumentation
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Magnetic Resonance Imaging
- Male
- Pregnancy
- Radiography, Interventional
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography, Doppler, Color
- Ultrasonography, Prenatal/methods
- Young Adult
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Affiliation(s)
- Stephen L Ferrara
- Department of Radiology, Naval Medical Center, San Diego, California, USA.
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Muroya T, Koga S, Maemura K. Chronic renal artery dissection with aneurysm formation treated by stent implantation with coil embolization with detailed intravascular ultrasound evaluation. Catheter Cardiovasc Interv 2012; 81:574-7. [PMID: 22511619 DOI: 10.1002/ccd.24308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 12/21/2011] [Indexed: 11/10/2022]
Abstract
Treatment options for chronic renal artery dissection, which is a rare cause of renal artery stenosis and renovascular hypertension, such as medical management, percutaneous intervention, and open surgical repair remain controversial. We describe a 55-year-old man with a chronic dissecting aneurysm of a renal artery complicated with renovascular hypertension that was initially diagnosed by computed tomography angiography, evaluated by intravascular ultrasound, and treated by stent implantation with coil embolization.© 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Takahiro Muroya
- Department of Cardiology, Ureshino Medical Center, Ureshino, Japan
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Seo JM, Park KB, Kim KH, Jeon P, Shin SW, Park HS, Do YS, Kim DI, Kim YW. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography. Acta Radiol 2011; 52:854-9. [PMID: 21840966 DOI: 10.1258/ar.2011.110063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA. MATERIAL AND METHODS Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The postembolization MDCT follow-up findings were analyzed retrospectively. RESULTS The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and postprocedural hypertension developed in two patients during the follow-up period. CONCLUSION The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension.
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Affiliation(s)
- Jung Min Seo
- Department of Radiology and the Center for Imaging Science
| | - Kwang Bo Park
- Department of Radiology and the Center for Imaging Science
| | - Keon Ha Kim
- Department of Radiology and the Center for Imaging Science
| | - Pyoung Jeon
- Department of Radiology and the Center for Imaging Science
| | - Sung Wook Shin
- Department of Radiology and the Center for Imaging Science
| | - Hong Suk Park
- Department of Radiology and the Center for Imaging Science
| | - Young Soo Do
- Department of Radiology and the Center for Imaging Science
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Stent-assisted Coil Embolization of Renal Artery Bifurcation Aneurysm Using the Kissing Stent Technique. J Vasc Interv Radiol 2011; 22:1485-7. [DOI: 10.1016/j.jvir.2011.01.456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 01/26/2011] [Accepted: 01/29/2011] [Indexed: 11/18/2022] Open
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Treating coil migration in combination therapy involving stenting and coiling for a wide-necked renal aneurysm. Cardiovasc Interv Ther 2011; 26:286-9. [PMID: 24122599 DOI: 10.1007/s12928-011-0072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
Abstract
A man with a wide-necked renal artery aneurysm underwent combination therapy involving stenting and coiling to embolize it. However, a large section of one of the coils had migrated outside the stent implanted across the orifice of the aneurysm. After repositioning the migrated coil inside the stent, the implantation of another stent together with sandwiching of the coil between two stents repaired the prolapsed coil. This report describes precautions that should be taken during combination therapy involving stenting and coiling to embolize a wide-necked aneurysm.
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Vulev I, Klepanec A, Madaric J, Tomka J, Sefranek V. Endovascular treatment of a giant aorto-ostial renal artery pseudoaneurysm. Ann Vasc Surg 2011; 25:1140.e13-6. [PMID: 21835587 DOI: 10.1016/j.avsg.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/18/2011] [Accepted: 04/04/2011] [Indexed: 11/28/2022]
Abstract
Vascular complications after lumbar laminectomy are rare, but are potentially life-threatening. A 59-year-old man presented with progressive and worsening abdominal pain over several weeks. Multidetector computed tomography angiography revealed a large aorto-ostial left renal artery pseudoaneurysm 3 years after lumbar laminectomy. The pseudoaneurysm was successfully treated with a combination of various endovascular techniques ("jailed" microcatheter technique, stent-graft implantation, thrombin injection, balloon remodeling technique, Onyx application), with preserved patency of the left renal artery and pseudoaneurysm exclusion on 6-month follow-up multidetector computed tomography angiography. The size and location of this pseudoaneurysm and the combination of different techniques for endovascular treatment provides an update on current endovascular technology. Combination of different endovascular techniques can be a safe and feasible alternative for the treatment of complicated iatrogenic postlaminectomy vascular injuries and renal artery pseudoaneurysms.
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Affiliation(s)
- Ivan Vulev
- Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
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Hur S, Yoon CJ, Kang SG, Dixon R, Han HS, Yoon YS, Cho JY. Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol 2011; 22:294-301. [PMID: 21353982 DOI: 10.1016/j.jvir.2010.11.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 10/28/2010] [Accepted: 11/09/2010] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of two transcatheter arterial embolization (TAE) techniques used to treat pseudoaneurysms of the gastroduodenal artery (GDA) stump after pancreaticoduodenectomy. MATERIALS AND METHODS Between March 2003 and March 2008, 16 patients were treated with TAE for pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Two embolization techniques were employed: endovascular trapping of the hepatic artery (embolization of the hepatic artery proximal and distal to GDA stump; group A; n = 13) and selective embolization of the GDA stump and/or pseudoaneurysm sparing hepatic arterial flow (group B; n = 3). Technical success, initial hemostasis, recurrence of bleeding, and complications were compared between the two groups retrospectively. RESULTS All TAE procedures were technically successful and immediate hemostasis was achieved in all patients. There was no recurrent bleeding in group A; however, all three patients in group B experienced recurrent bleeding after initial hemostasis (P = .002), and these patients required subsequent embolization with the endovascular trapping technique. Two patients died of multiple organ failure (one patient in each group) despite successful hemostasis. Three patients experienced subsegmental (n = 1, group A) and multisegmental (n = 2, group B) liver infarction, which were successfully managed with conservative treatment. There was a higher incidence of major complications in group B (15.4% vs 100%; P = .018). CONCLUSIONS Endovascular trapping of the hepatic artery is a safe and effective treatment of pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Hepatic ischemic complications are not rare, but can be conservatively managed. Selective embolization of the GDA stump and/or pseudoaneurysm is frequently associated with recurrence of bleeding, which eventually leads to major complications.
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Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea
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Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience. Radiol Med 2011; 116:945-59. [PMID: 21509547 DOI: 10.1007/s11547-011-0684-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE This study reviews our experience over the last 10 years with procedures of embolisation and/or exclusion of the renal arteries, their parenchymal branches and the polar arteries [renal artery embolisation (RAE)]. MATERIALS AND METHODS Twenty-seven patients (19 men and eight women; age range 37-93 years; mean 74 years) underwent RAE. The indications were: symptomatic gross haematuria in nine patients (33.3%) (tumour-related in seven and iatrogenic in two), symptomatic inoperable renal tumour in five (18.5%), large subcapsular or perirenal haematoma in three (11.1%) and aneurysm of the main renal artery in two (7.4%). Eight patients (29.6%) scheduled for endovascular aneurysm repair (EVAR) of the abdominal aorta underwent prophylactic embolisation of the renal polar branch arising from the aneurysmal sac or the subrenal aortic neck to prevent the possible revascularisation of the sac. Different embolisation agents were used: coils (17 cases), embolisation particles (14 cases), glue (one case), coated stent (two cases) and mechanical occlusion devices (two cases). In 11 cases, two to three different embolisation agents were used together. RESULTS Technical success was achieved in 26/27 patients (96.3%); in one case, embolisation of a polar artery arising from the aneurysmal sac was not possible. One case of gross haematuria recurred 13 months after the procedure and was re-treated with success. There were no cases of major or minor complications. CONCLUSIONS RAE is an effective and minimally invasive procedure in the treatment of neoplastic/iatrogenic symptomatic gross haematuria and in the palliative treatment of inoperable renal tumours. One possible new indication is the prophylactic exclusion of the polar artery arising from the neck or the sac of an abdominal aortic aneurysm in patients who are candidates for EVAR. In our experience, we observed very low morbidity and a short hospital stay. This procedure requires the availability of various materials for performing embolisation and experience in their use.
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Endovascular Techniques for the Treatment of Renal Artery Aneurysms. Cardiovasc Intervent Radiol 2011; 34:926-35. [DOI: 10.1007/s00270-011-0127-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
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Robinson WP, Bafford R, Belkin M, Menard MT. Favorable outcomes with in situ techniques for surgical repair of complex renal artery aneurysms. J Vasc Surg 2011; 53:684-91. [DOI: 10.1016/j.jvs.2010.10.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 09/24/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
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Schlunz-Hendann M, Wetter A, Landwehr P, Brassel F. Stent-assisted coil embolization of a traumatic wide-necked renal segmental artery pseudoaneurysm. Cardiovasc Intervent Radiol 2011; 34:1065-8. [PMID: 21301845 DOI: 10.1007/s00270-011-0105-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 08/20/2010] [Indexed: 11/28/2022]
Abstract
We present the case of an Afghan woman with a renal segmental artery false aneurysm of the right kidney due to a shell splinter injury. Stent-assisted coil embolization of the aneurysm is described in detail.
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Affiliation(s)
- Martin Schlunz-Hendann
- Clinic of Radiology and Neuroradiology, Duisburg Clinical Center, Zu den Rehwiesen 9-11, 47055 Duisburg, Germany
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Cura M, Elmerhi F, Bugnogne A, Palacios R, Suri R, Dalsaso T. Renal aneurysms and pseudoaneurysms. Clin Imaging 2011; 35:29-41. [DOI: 10.1016/j.clinimag.2009.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/03/2009] [Indexed: 01/16/2023]
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Delayed intracranial hemorrhage associated with antiplatelet therapy in stent-assisted coil embolized cerebral aneurysms. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 110:133-9. [PMID: 21125459 DOI: 10.1007/978-3-7091-0356-2_24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Administration of oral clopidogrel plus aspirin is the most important regimen to reduce thromboembolic complications in stent-assisted coil embolization of cerebral aneurysm. However, such therapy may increase the risk of hemorrhage. The purpose of this study is to analyze the effect of two different antiplatelet regimens on hemorrhagic and thromboembolic complication rates around the stent-assisted coil embolization period. Records over a 2-year period were reviewed in a retrospective cohort study. For 49 consecutive stent-assisted coil embolization procedures over 41 patients, nine patients received routine antiplatelet drugs (300 mg aspirin and 75 mg clopidogrel) for 3 days before embolization, and 32 received a loading dose of antiplatelet drugs (300 mg aspirin and 300 mg clopidogrel) just before induction of anesthesia. Delayed intracerebral hemorrhage (DIH) was observed more often in the routine antiplatelet group (2/9 cases, 22.2%) in comparison with the loading group (0/32 cases, 0%; P = 0.044; Fisher exact test). The two hemorrhagic cases were both female, and occurred within 24 h of postembolization. The thromboembolic complication rates were not significantly different between the two groups. Oral administration of routine antiplatelet drugs for 3 days before stent-assisted coil embolization possibly increases the risk of delayed intracranial hemorrhage, compared to loading group. Symptomatic thromboembolic complications have no significant difference in the two different regimens.
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Schoppe KA, Ciacci J, Bettmann M. Modified stent-supported coil embolization for treatment of a splenic artery pseudoaneurysm. J Vasc Interv Radiol 2010; 21:1452-6. [PMID: 20691607 DOI: 10.1016/j.jvir.2010.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 02/16/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022] Open
Abstract
A patient presented 2 weeks after distal pancreatectomy and splenectomy with increased bloody output from his surgical drain. Catheter angiography found an enlarging splenic artery stump pseudoaneurysm. During the procedure, there was concern that nontarget embolization may occur, given the short splenic artery remnant. Pseudoaneurysm thrombosis was subsequently achieved using a variation of stent-supported coil embolization. At 3-month follow-up, the patient had no recurrent bleeding from the surgical site. Although this technique has been described in the treatment of neurovascular and renal artery aneurysms, it is applicable to, and readily adapted for, use in visceral arterial procedures.
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Affiliation(s)
- Kurt A Schoppe
- Department of Radiology, Division of Radiological Sciences, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Chandra A, O'Connell JB, Quinones-Baldrich WJ, Lawrence PF, Moore WS, Gelabert HA, Jimenez JC, Rigberg DA, DeRubertis BG. Aneurysmectomy With Arterial Reconstruction of Renal Artery Aneurysms in the Endovascular Era: A Safe, Effective Treatment for Both Aneurysm and Associated Hypertension. Ann Vasc Surg 2010; 24:503-10. [DOI: 10.1016/j.avsg.2009.07.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/08/2009] [Accepted: 07/21/2009] [Indexed: 11/16/2022]
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Ginat DT, Saad WEA, Turba UC. Transcatheter renal artery embolization: clinical applications and techniques. Tech Vasc Interv Radiol 2010; 12:224-39. [PMID: 20005480 DOI: 10.1053/j.tvir.2009.09.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Renal artery embolization is a minimally invasive procedure that is increasingly being used for treatment of a wide range of conditions. The main indications for renal artery embolization include (1) prenephrectomy and preradiofrequency ablation infarction of renal tumors, (2) management of renal angiomyolipomas, (3) palliations of unresectable renal malignancy, (4) renal hemorrhage (life-threatening or chronic debilitating hematuria), (5) arteriovenous fistulas, (6) vascular malformations, (7) renal artery aneurysms and pseudoaneurysms, and other less common indications, such as severe hydronephrosis and hypertension. A variety of embolic materials are available, such as metal coils, sclerosants (glue, Onyx, absolute ethanol, lipiodol), and particulate embolic agents (polyvinyl alcohol particles and embospheres). Selection of the appropriate agent depends on the clinical application, technical and clinical endpoints, as well as the pathology lesion(s) targeted. Renal artery embolization can be performed alone or in combination with remodeling techniques, stent-grafting, and balloon- or stent-assisted coiling in more complicated cases. The procedure is generally regarded as safe and effective for diverse applications and is considered as an evolving area in the field of endoluminal therapy.
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Affiliation(s)
- Daniel T Ginat
- Department of Imaging Science and Interventional Radiology, University of Rochester Medical Center, Rochester, NY 14642-8648, USA.
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Wajnberg E, Aquino D, Spilberg G. Experiência preliminar com o uso da técnica de "remodelagem de colo" para tratamento endovascular de aneurismas complexos da artéria renal. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000100009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Relatar os resultados preliminares da aplicação da técnica de "remodelagem do colo" no tratamento dos aneurismas de colo largo da artéria renal. MATERIAIS E MÉTODOS: Cinco pacientes (três mulheres e dois homens, com idade média de 62 anos, intervalo de 49-72 anos) com aneurismas da artéria renal variando de 10 a 25 mm de diâmetro, de colo largo, foram tratados com técnicas de embolização assistidas por "remodelagem do colo" com balão durante o período de três anos. O microbalão era posicionado diante do colo do aneurisma e insuflado, temporariamente, durante a colocação das micromolas destacáveis no interior do aneurisma. RESULTADOS: O posicionamento do balão e a colocação das micromolas foram realizados com êxito em todos os casos. Oclusão completa do aneurisma, sem protrusão de micromolas ou obstrução do vaso parental, foi alcançada em todos os pacientes. CONCLUSÃO: Nossa experiência preliminar indica que a aplicação da técnica de "remodelagem do colo" no tratamento dos aneurismas de colo largo da artéria renal é tecnicamente viável e eficaz para o tratamento endovascular de aneurismas complexos da artéria renal, sem o sacrifício de qualquer ramo arterial.
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Altit R, Brown DB, Gardiner GA. Renal Artery Aneurysm and Arteriovenous Fistula Associated with Fibromuscular Dysplasia: Successful Treatment with Detachable Coils. J Vasc Interv Radiol 2009; 20:1083-6. [DOI: 10.1016/j.jvir.2009.04.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 04/07/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022] Open
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