Giant Renal Artery Aneurysms

Abstract

Renal artery aneurysms (RAAs) are rare, relatively small, and do not need to be treated in most instances. Giant RAAs (> 5.0 cm in diameter), however, may require a different approach. Two women, both 75 years old, were treated at the authors' institution for giant RAAs. One patient, with a single kidney, was diagnosed with acute renal failure as a result of ureteral obstruction by a 6.0-cm RAA. The other RAA was found incidentally on a plain abdominal radiograph performed for right flank pain; severe hypertension was present in this patient. Computerized tomography (CT) scan in this patient demonstrated a left RAA with a maximal diameter of 6.5 cm. Arteriography was obtained in both patients. Both aneurysms were located adjacent to the hilum of the kidney arising from a major branch of the main renal artery near the branch's origin. Both had evidence of partial calcification within the wall. The patients were treated surgically with partial excision and ligation. In the first patient, surgery was necessary to relieve ureteral obstruction, whereas hypertension control was the main goal in the other. The patients did well with maintenance of renal function postoperatively. Giant RAAs may cause pain, obstruction of the ureter, or renal vascular hypertension. Resolution of these symptoms can be expected with proper surgical intervention as well as elimination of the potential risk for rupture.