Endovascular techniques for the treatment of true renal arterial aneurysms-procedural insights and outcomes.

PURPOSE: To discuss endovascular techniques and report the outcomes for endovascular treatment of true renal arterial aneurysms (TRAAs).

MATERIALS AND

METHODS

A 22-year retrospective analysis of endovascular treatment of TRAAs in our institution. Aneurysm characteristics and endovascular techniques are discussed. Outcome measures were technical and clinical success (need for reintervention), renal parenchymal perfusion loss, impact on renal function, and complications. A 30-day mortality analysis was performed. Impact on renal function was assessed with a two-tailed, paired t-test of pre- and post-procedural serum creatinine.

RESULTS

Eighteen endovascular procedures were performed to treat 15 TRAAs in 14 patients (including three reinterventions). 14/15 TRAAs were classified as Type 2 and 1/15 as Type 1 (Rundback classification). Mean initial aneurysm size was 22.9 mm (range 5-40 mm). Of the 14 Type 2 TRAAs, five were initially treated with balloon-assisted Onyx embolisation, four with stent-assisted coiling, four with sac packing, and one with stent-grafting. The technical success rate was 100%. The TRAAs requiring reintervention had been originally treated with balloon-assisted Onyx embolisation (two TRAAs) and stent-grafting (one TRAA). Renal parenchymal loss was < 10% in 10/15 TRAAs after initial intervention. At reintervention, 2/3 cases had 60-70% estimated parenchymal loss as the TRAAs had to be treated more aggressively. Complications (grade 1-3) occurred in 5/18 procedures. The grade 2 complication was atrophy and loss of renal function of the treated kidney (with serum creatinine remaining in the normal range) (n = 1). Grade 3 complications were brachial access pseudoaneurysm (n = 1), common femoral vein thrombosis (n = 1), and access site cellulitis (n = 1).

CONCLUSION

Endovascular treatment of TRAAs has a high rate of technical success and a low impact on renal function. A higher rate of reintervention was observed for TRAAs treated with Onyx embolisation, leading to a shift towards stent-assisted coiling as our preferred technique when anatomically feasible.