Renal Aneurysms: Repair Before Rupture

Identifying and treating renal artery aneurysm

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.

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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.

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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.

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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.

Daniel Clair, MD

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.
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