Renal artery aneurysm is a rare entity in clinical practice. The exact etiology remains unknown, but several risk factors have been detected, including congenital disorders of connective and vascular tissue and long-standing hypertension with ensuing atherosclerosis. The majority of patients are asymptomatic and the diagnosis is often made incidentally. Flank pain, hematuria, and hypertension are reported in symptomatic cases. Imaging studies, such as ultrasonography and computed tomography (CT) are necessary to identify the aneurysm and its size. Surgery is usually the therapeutic method of choice.
The clinical presentation of a renal artery aneurysm (RAA) is often asymptomatic, as up to 55% of cases are without any complaints at the time of diagnosis  . Hypertension is, however, by far the most common finding, but it is rarely considered to be a specific sign of RAA   . Mean blood pressure measurements at the time of identification of the disease are about 150/90 mmHg and patients often suffer from hypertension for several years prior to aneurysm treatment . Accompanying symptoms that have been reported include flank pain and hematuria ranging from microscopic to very large macroscopic hematuria  . In rare cases, a pulsatile abdominal mass (only seen in very large aneurysms) and vascular bruits might be observed . Complications of renal artery aneurysms are very rare, but rupture of this structure occurs in 3% of cases and predisposes individuals to fatal hemorrhage , meaning that an early diagnosis is critical. In addition to hypertension, renal artery fibrodysplasia was established as an important risk factor in the pathogenesis of RAA, followed by atherosclerotic plaques that occlude the artery and promote hypertension, but also tobacco smoking  . RAAs can be solitary or multiple (either in unilateral or bilateral distribution), and a relatively equal predisposition of left and right vessels is observed . Some studies, however, claim it is more frequent in men (around 60 years of age) and that the right renal artery is the predominant site for an aneurysm formation  .
Entire Body System
- Soft Tissue Mass
Marfan syndrome, Ehlers-Danlos syndrome trauma 1,2 CT noncontrast: soft tissue mass lesion in the region or course of renal artery postcontrast: contrast-filled outpouching in the course of the renal artery Angiography Aneurysms can be well detected and [radiopaedia.org]
- Wound Infection
Aside from abscess, bleeding and wound infection, possible complications include death, need for nephrectomy, early or (approximately 10% of cases) delayed graft occlusion 8 and branch artery stenosis or occlusion after aneurysm resection, which may require [invasivecardiology.com]
- Right Flank Pain
Discussion In 1770, Rouppe found a large false renal aneurysm with rupture in an autopsy of a patient who died with right flank pain. [vasculardiseasemanagement.com]
Intrarenal pseudoaneurysm presenting with microscopic hematuria and right flank pain. Can J Urol. 2007 Jun. 14(3):3588-91. [Medline]. Rautio R, Haapanen A. Transcatheter embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer. [emedicine.medscape.com]
- Abdominal Bruit
Otherwise, patients may present with arterial hypertension, pain, hematuria, abdominal pulsatile mass or abdominal bruit. Hypotension, shock and acute abdomen may be caused by a ruptured aneurysm. [urology-textbook.com]
- Recurrent Abdominal Pain
A 57-year-old male smoker with a history of recurrent abdominal pain was diagnosed with a 5.1-cm right renal artery aneurysm near the hilum. [ncbi.nlm.nih.gov]
- Vascular Disease
Overview Renal Artery Aneurysms Renal Vascular Disease What is renal vascular disease? Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. [indiahospitaltour.com]
Even though the present case represents an extremely rare clinical manifestation of intraparenchymal renal artery aneurysm, clinicians should be aware that imaging studies cannot distinguish all instances of renal vascular disease. [ncbi.nlm.nih.gov]
Patient Care & Services Renal Vascular Disease What is renal vascular disease? Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. [surgery.med.miami.edu]
The diagnosis of a renal artery aneurysm may not be so easy to attain, especially in the absence of symptoms. Given the frequent incidental finding of an RAA, the increased use of imaging modalities for the purposes of screening or evaluation of other organs have markedly increased the number of identified cases   . For this reason, the physician must obtain a thorough patient history and conduct a meticulous physical examination that focuses on the assessment of blood pressure. A family history is also important in the initial interview, as the autosomal dominant polycystic disease, tuberous sclerosis, and other congenital disorders carry a higher rate of RAA  . As soon as clinical suspicion is raised, imaging studies need to be employed. Various procedures are recommended, including ultrasonography (with doppler technique), CT, magnetic resonance imaging (MRI), nuclear scintigraphy, and MR angiography (MRA)  . Ultrasonography is used as a first-line study that provides a good view into the renal vessels and is often recommended as a screening method every 6-12 months when smaller aneurysms are identified , but either CT (contrast-enhanced) or MRA are considered to be the gold standard, with very high rates of detection  . The importance of more advanced procedures lies in the fact that aneurysm size, as well as type, must be determined, mainly in order to devise the optimal therapeutic strategy.
We report a case of endovascular treatment of a complex renal artery aneurysm using the Pipeline Embolization Device, a flow diverting stent which is indicated for the treatment of large and giant cerebral aneurysms. [ncbi.nlm.nih.gov]
Other indications for treatment include rupture, aneurysms in females contemplating pregnancy and aneurysms associated with dissection. Several surgical or endovascular method can be recruited for treatment. [apscvir.com]
Treatment and prognosis Management depends on various factors like age, sex, severity of hypertension, anticipated pregnancy, and aneurysm morphology. [radiopaedia.org]
Herrlin Renal artery aneurysms: natural history and prognosis Ann Surg, 197 (1983), pp. 348-352  P.K. Henke, J.D. Cardneau, T.H. [elsevier.pt]
Aneurysms of the renal artery: Problems of prognosis and surgical management. Surgery 1978;84:563–572. 9. Sahin S, Okbay M, Cinar B, Uzunlulu N. Wide-necked renal artery aneurysm: Endovascular treatment with stent-graft. [vasculardiseasemanagement.com]
Renal artery aneurysm is a rare condition that has an unclear etiology. Although some patients present with symptoms of hypertension, pain, hematuria, or rupture, the majority are asymptomatic. [ncbi.nlm.nih.gov]
Etiological research of aneurysms showed no underlying vasculitis. [casereports.in]
Etiology fibromuscular dysplasia (FMD): 35% degenerative aneurysm: 25% vasculitides, e.g. Behcet disease phakomatoses, e.g. tuberous sclerosis, neurofibromatosis intrinsic collagen deficiency, e.g. [radiopaedia.org]
The exact etiology remains unknown, but several risk factors have been detected, including congenital disorders of connective and vascular tissue and long-standing hypertension with ensuing atherosclerosis. [symptoma.com]
We describe the case and review the literature surrounding the epidemiology, outcome and management of renal artery aneurysms. [ncbi.nlm.nih.gov]
Epidemiology 1:300 to 1:1000. Etiology of renal artery aneurysm Congenital disorder, arteriosclerosis, traumatic or iatrogenic causes, inflammation. Signs and Symptoms In 50%, an aneurysm of the renal artery does not cause any symptoms. [urology-textbook.com]
Causes include the following: Polyarteritis nodosa Tuberculosis Neurofibromatosis Epidemiology Autopsy studies indicate that the incidence of RAA is in the range of 0.01-0.09%.  In selected patients who undergo renal arteriography, a higher incidence [emedicine.medscape.com]
If symptoms occur, or enlargement of the aneurysm, then endovascular or open repair should be considered.  Pregnant women (due to high rupture risk of up to 80%) should be treated surgically.  Epidemiology [ edit ] Incidence rates of cranial aneurysms [en.wikipedia.org]
The pathophysiology of hypertension in patients with RAAs is not well understood but may be related to localized ischemia secondary to kinking of the renal artery branch, turbulence in the aneurysm, distal embolization from the aneurysm, or coexisting [evtoday.com]
RAAs are associated with hypertension in up to 73% of cases. 3 Hypotheses on the pathophysiological basis of hypertension include microembolization from the aneurysm, coexisting renal artery stenosis, compression or kinking of the renal artery or its [elsevier.pt]
Pathophysiology In true aneurysms, a weakening then dilatation of all layers of the arterial wall occurs. In fibromuscular dysplasia (FMD), the degenerative fibroplasia-type changes lead to this wall weakening. [emedicine.medscape.com]
We performed ex vivo reconstruction using an organ preservation solution to prevent postoperative renal failure. [ncbi.nlm.nih.gov]
WHO WE ARE Center for Vascular Awareness, Inc. is a 501(c)(3) not for profit organization dedicated to fostering mainstream consumer and clinical consciousness of vascular health standards, disease, prevention and treatment options. [myvascularhealth.org]
The aneurysms were treated with placement of a polytetrafluoroethylene (PTFE)-coated stent, in order to prevent expansion and rupture of the aneurysms and to treat the hypertension. [elsevier.pt]
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- Seo PW. Surgical Treatment of Ruptured Renal Artery Aneurysm: A Report of 2 Cases. Korean J Thorac Cardiovasc Surg. 2013;46(6):467-470/
- Titze N, Ivanukoff V, Fisher T, Pearl G, Grimsley B, Shutze WP. Surgical repair of renal artery aneurysms. Proc (Bayl Univ Med Cent). 2015;28(4):499-501.
- Wason SE., Schwaab T. Spontaneous Rupture of a Renal Artery Aneurysm Presenting as Gross Hematuria. Rev Urol. 2010;12(4):e193-e196.
- Tham G, Ekelund L, Herrlin K, et al. Renal artery aneurysms. Natural history and prognosis. Ann Surg. 1983;197:348–352.
- Porcaro AB, Migliorini F, Pianon R, et al. Intraparenchymal renal artery aneurysms. Case report with review and update of the literature. Int Urol Nephrol. 2004;36:409–416.