Renal Aneurysms: Repair Before Rupture

kidneys

Seems odd that a bulging, weakened area in the wall of an artery to the kidney could go unnoticed for some time. But there are usually no symptoms for renal artery aneurysms (RAA), and the condition may go unnoticed unless a person is getting imaging for some other reason.

These aneurysms can sometimes lead to hypertension, but risk of rupture is a real concern once they grow larger than the size of a penny (2 cm). That’s when repair is recommended.

Causes of RAA

One explanation is atherosclerosis, or hardening of the arteries. And RAA seems to be related to fibromuscular dysplasia (FMD), a disease that causes arteries to narrow. Most people with this condition are 40 to 60 years old, and many are women.

Diagnosis of RAA

So, what happens if RAA is suspected? It’s important to get a clear picture of the aneurysm and its neighboring branches. A computed tomography angiography (CTA) gives the best anatomic view of the aneurysm and arteries branching off of it.

Treatment options for RAA

While 98 percent of aneurysms occur outside of the kidney, if they involve more than one branch, open surgery is the gold standard for repair—the goal being to preserve all of the branches off of the aneurysm.

Sometimes, repair is more complex and the kidney is removed so the aneurysm can be repaired, and then re-implanted, much like a kidney transplant. This allows doctors to preserve the kidney during very complex procedures.

If the doctor’s orders are to operate, expect to be in the hospital for three to five days and back to regular activities within a month. A minority of patients—fewer than 15 percent—can have minimally invasive procedures that take a day and require about a week of recovery before returning to daily activities.

It’s important to go to a multi-specialty hospital because many of these procedures are performed with surgeons from urology and vascular surgery to facilitate the repair of complex aneurysms.

avatar

Daniel Clair, MD

Daniel Clair, MD, is Chairman of the Department of Vascular Surgery at Cleveland Clinic. In 2007, Dr. Clair was named one of America’s Top Doctors.
  • Harvey

    It’d be nice to know how an informed vegan diet compares to other diets, healthwise. In terms of animal rights it’s easy to compare.

  • TV53

    I’m sorry, but there is plenty of scientific data to back diets by Esselstyn, Ornish, and others. It must drive Dr. Esselstyn crazy to read articles like this coming from his own organization. The Pritiken center has released dozens of studies over the years, and Medicare thinks enough of the Ornish diet to now provide coverage. I guess if Esselstyn’s 20 year study, and more recent 200 person study don’t qualify as data, with their remarkable results, then I guess there’s no convincing you. Then again, you recommend a low carb diet despite the enormous volume of evidence that these diets are harmful over the long run, so it’s pretty clear that this article is not taking full account of the weight of evidence. Maybe all the local doctors who end up calling Dr. Esselstyn to help with their own heart issues might have a different opinion.

  • Ken

    Sad to see this advice with little or no reference to the impact of plant based diets on preventing and curing heart diseases, especially out of the Cleveland Clinic. Is anybody there looking at all the latest research on the impact of plant based diets on heart diseases?

  • http://www.myitnet.com Duke G

    It looks like there is a typo in this sentence:Folate and B vitamins have low risk as supplements, but there is little evidence there is improvement in PAD or lowered cardiovascular risk with these agents. They also can be harmful in patients with kidney disease. Low dose intake(400g) has been recommended for overall health.
    I doubt that 400 grams is recommended. Likely milligrams – mg.

    • The_Beating_Edge_Team

      thank you for the note! We have corrected it to (400 mcg)

  • ethel burton

    hi is there anybody out there who has a vein trapped in a curved spine that as turned to bone the vascular surgeon says he cannot remove the bone as it is too dangerous but he can put a baloon inside to open up my vein so the blood can flow better

    • The_Beating_Edge_Team

      Ethel, I spoke to Dr. Clair about your question and he stated that you should have a second opinion evaluation by a physician who sees these problems regularly. If you would like to see one of our doctors or have an online second opinion, let us know. We are happy to help you. http://www.clevelandclinic.org/heartnurse betsyRN