Clinical Outcomes of Endovascular and Surgical Treatments for Renal Artery Aneurysm.

BACKGROUND

A renal artery aneurysm (RAA) is usually asymptomatic and requires no treatment. RAAs larger than 2-3 cm however are at risk of rupture and typically require intervention. This study analyzed the clinical outcomes of endovascular and surgical treatments for RAA.

METHODS

This single-center retrospective observational study reviewed 52 RAA procedures performed between January 2011 and December 2024. Baseline patient characteristics, aneurysm anatomy, and clinical outcomes-including technical success, postprocedural renal infarction, perioperative outcomes, and long-term renal outcomes-were compared between endovascular and surgical groups.

RESULTS

The mean RAA size was 2.5 cm (range, 0.8-6.5 cm). Endovascular treatment was performed in 28 procedures (17 coil embolizations, 8 stent-assisted coil embolizations, and 3 stent graft insertions), and surgical treatment in 24 procedures (15 in situ repairs, 9 autotransplantations). Technical success was 100% in both groups. Renal infarction occurred more frequently in the endovascular group (67.9% vs. 37.5%; P = 0.03), driven primarily by minimal infarction. The incidence of acute kidney injury (AKI) (10.7% vs. 29.2%; P = 0.16), renal artery occlusion (7.1% vs. 0%; P = 0.49), chronic kidney disease (CKD) stage ≥ 3 (14.3% vs. 4.2%; P = 0.36), and mean glomerular filtration rate (GFR) change (-15.71 vs. -13.92; P = 0.59) did not differ significantly between groups.

CONCLUSION

Both endovascular and surgical treatments for RAA demonstrate high technical success and preservation of renal function. Endovascular treatment is associated with a higher incidence of renal infarction and potentially delayed vascular complications; however, long-term renal outcomes were comparable. Treatment selection should be individualized based on aneurysm anatomy and patient-specific considerations.