You are here: Urology Textbook > Kidneys > Renal artery aneurysm

Diagnosis and Treatment of Renal Artery Aneurysm

Definition of Renal Artery Aneurysm

A renal artery aneurysm is an increase in the renal artery diameter to more than 1.5 times the normal vessel diameter, which is classified according to the specific morphology:

True aneurysm:

An outpouching involving all layers of the vessel wall; the morphology may be asymmetric and saccular or uniformly cylindrical. As dilation progresses, the stability of the arterial wall decreases. True aneurysms account for the majority of renal artery aneurysms.

Pseudoaneurysm or false aneurysm:

A false aneurysm (pseudoaneurysm) results from injury to the vessel wall, most commonly iatrogenic, traumatic, or inflammatory, with formation of a pulsatile extravascular hematoma that remains in arterial communication.

Dissecting aneurysm:

An intimal tear allows blood flow between the layers of the vessel wall, resulting in aneurysmal dilation.

Arteriovenous aneurysm:

Aneurysmal changes arising from an arteriovenous fistula of the renal vessels.

Angiography and CT scan of a true left renal artery aneurysm with incomplete circumferential calcification and a diameter greater than 2.5 cm. With kind permission, Prof. Dr. R. Harzmann, Augsburg.

Epidemiology

1:300 to 1:1000, most of them without the need for therapy. Rupture of a renal artery aneurysm is rare, with a mortality rate of around 10%. In the event of rupture during pregnancy, maternal and fetal mortality are substantially higher.

Etiology of renal artery aneurysm

Congenital, atherosclerosis, fibromuscular dysplasia, traumatic, postinterventional (iatrogenic), vasculitides.

Signs and Symptoms

Many renal artery aneurysms are asymptomatic incidental findings. Possible symptoms include arterial hypertension, pain, hematuria, a pulsatile abdominal mass (rare), or an abdominal bruit. Hypotension, shock, and an acute abdomen may result from aneurysm rupture.

Diagnostic Workup of Renal Artery Aneurysm

• Doppler Ultrasound: Serves as an initial screening examination; however, its diagnostic accuracy depends on the examiner and the anatomic conditions.
• CT Angiography: Noninvasive imaging modality for diagnostic confirmation, size assessment, evaluation of calcification, and treatment planning.
• MR Angiography: An alternative in patients with contraindications to iodinated contrast media or when repeated follow-up imaging is required.
• Catheter Angiography: The invasive gold standard for detailed vascular delineation, particularly when endovascular treatment is planned.

Treatment of Renal Artery Aneurysm

The indications for endovascular procedures (stent placement) or open surgical treatment (excision and reconstruction of the renal artery) are:

• Diameter >2.5–3 cm
• Pseudoaneurysm at risk of rupture.
• Symptomatic lesion with flank pain, hematuria, renin-dependent hypertension, or clinically significant embolization.
• Rapid increase in size during follow-up; incomplete circumferential calcification is an additional risk factor.
• Impending pregnancy increases the risk of rupture.
• Arteriovenous fistula.

References

Nosher, J. L.; Chung, J.; Brevetti, L. S.; Graham, A. M. & Siegel, R. L. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy.
Radiographics, 2006, 26, 1687-704; quiz 1687.

  Deutsche Version: Aneurysma der Nierenarterie

Urology-Textbook.com – Choose the Ad-Free, Professional Resource

This website is designed for physicians and medical professionals. It presents diseases of the genital organs through detailed text and images. Some content may not be suitable for children or sensitive readers. Many illustrations are available exclusively to Steady members. Are you a physician and interested in supporting this project? Join Steady to unlock full access to all images and enjoy an ad-free experience. Try it free for 7 days—no obligation.

New release: The first edition of the Urology Textbook as an e-book—ideal for offline reading and quick reference. With over 1300 pages and hundreds of illustrations, it’s the perfect companion for residents and medical students. After your 7-day trial has ended, you will receive a download link for your exclusive e-book.