What Is a Renal Artery Aneurysm?

Renal aneurysms are not uncommon, accounting for about 19% of visceral aneurysms. 80% were unilateral, 17% were intrarenal, and 30% were multiple. The incidence is roughly the same for both men and women, with about 50% of the cases being diagnosed around the age of 50. At first, its incidence was considered extremely low, and it was not uncommon until after selective renal angiography was applied. The incidence is currently considered to be 0.1% to 0.3%. They can be divided into cystic aneurysms, spindle aneurysms, intrarenal aneurysms, dissecting aneurysms, and pseudoaneurysms according to their shape and location. Among them, cystic aneurysms are the most common, accounting for about 93%.

Basic Information

English name

aneurysm of renal artery

Visiting department

surgical

Common locations

kidney

Common causes

Arterial wall structural damage, blunt trauma to the waist, penetrating injuries, as well as puncture biopsy, intubation, collagen vascular disease, multiple arteritis, etc.

Common symptoms

High blood pressure causes dizziness, headache, chest tightness, palpitations, nausea, vomiting, hematuria, pain, etc.

Causes of renal aneurysms

Structural damage of arterial wall

Severe atherosclerosis causes renal arterial endometrial ulcers, middle-layer degeneration, elastic fiber rupture, and arterial stenosis after expansion; congenital fibromuscular dysplasia and Ai-Dang syndrome (EDS) -related weak elastic layers and vascular fragility Increases can cause aneurysm formation.

2. damage

Blunt trauma to the waist, penetrating injuries, and iatrogenic injuries such as puncture biopsy and intubation can lead to impaired renal artery wall integrity and aneurysm formation. Dissections and pseudoaneurysms are more common, especially the lower position of the right kidney, which is vulnerable to trauma. Because the wall of a pseudoaneurysm is composed of fibers and inflammatory tissues, it is very easy to rupture.

3. Autoimmune diseases

Such as collagen vascular disease, multiple arteritis, and tuberculosis, syphilis-related immune responses. Common in the kidney type, mostly multiple or bilateral disease.

Clinical manifestations of renal aneurysms

Hypertension is the most common symptom of renal aneurysms. The clinical feature is a continuous increase in blood pressure, which is more pronounced with diastolic blood pressure. General medications are difficult to control, and often have symptoms of dizziness, headache, chest tightness, palpitations, and nausea and vomiting. The reason is related to arterial stenosis, micro-renal infarction, and branch compression resulting in decreased renal blood perfusion.

Macroscopic or microscopic hematuria may occur in some patients, which is related to hypertension, aneurysm compression of the renal pelvis, thrombus shedding, and renal arteriovenous fistula formation leading to reflux disorders.

Expansion of renal aneurysm and compression of surrounding organs or renal infarction can cause persistent pain. Sudden abdominal pain should be alert to the possibility of rupture or threatened rupture. At this time, patients often develop symptoms of hemorrhagic shock.

Quite a few patients have no obvious subjective symptoms. When the tumor is large, the pulsatile mass can be touched. The upper abdomen can be heard and systolic murmurs can be heard.

Renal aneurysm examination

1.X-ray

On plain radiographs, about 1/4 of renal aneurysms can be calcified, and the calcifications are eggshell-like flower rings, which are mostly marginal calcifications, located near the renal hilum. Intravenous pyelography is mostly normal. If the aneurysm is enlarged, the filling defect can be seen.

2. Color Doppler ultrasound

Can understand the aneurysm, renal artery stenosis and blood flow. At the same time, because of its convenience and non-invasiveness, it is mostly used for screening.

3. Renal arteriography

Renal arteriography is the most reliable test method, which can directly show cystic bulge or spindle-shaped dilatation of the arterial wall, single or multiple can be large or small, and some arteriovenous fistulas can show early renal veins, and the supplying arteries have Compensatory thickening and distortion.

4.CT

CT plain scan is a slightly high density mass in or near the kidney, with clear and smooth borders and arc calcification at the edges. Enhancement scans are generally significantly enhanced, and the degree of enhancement is higher than the renal parenchyma and closer to the arteries. Sometimes it can be seen that the blood supply vessels are connected to the tumor. When thrombosis is formed, the enhancement may be uneven; when arteriovenous fistulas are combined, the contrast agent enters and exits quickly.

Renal aneurysm diagnosis

Most patients have no specific symptoms. For abdominal pulsatile masses or murmurs found on physical examination, plain films suggest circular calcification in the hilar region, unexplained hematuria, secondary hypertension, and exclusion of other diseases. The possibility of this disease should be considered. Clear diagnosis. Selective renal arteriography, digital subtraction, color Doppler ultrasound, and magnetic resonance imaging can be diagnosed.

Renal aneurysm treatment

The traditional treatment for renal aneurysms is surgery. The principle of traditional surgical treatment is to remove aneurysms and maintain normal renal function. Methods include resection of renal aneurysm combined with in situ repair, autologous vein or intervascular grafting or bypass; hypothermic perfusion in vitro, resection and repair of renal aneurysm, autologous kidney transplantation, etc.

In recent years, interventional therapy has become part of the first choice for renal aneurysms due to its small trauma, significant effect, simple and safe characteristics. Methods include embolization of aneurysms, and isolation of stent grafts.