Hilar Renal Artery Aneurysm Repair Using Coil Embolization and Covered Stent

Abstract

Introduction: Little has been reported regarding endovascular therapy with stent of renal artery hilar aneurysms. To that end, we herein report the outcomes of 3 hilar renal artery aneurysms (RAA) treated with an endovascular technique that makes use of a covered stent and coil embolization in the repair of hilar RAA and deem using this technique is better than traditional open approach with back-table repair and autotransplatation. Methods: Since November 2014, 3 consecutive patients have been referred to the vascular surgery service for evaluation of a right RAA; these patients’ aneurysms were diagnosed with a CT arteriogram prior to evaluation. These patients, typically treated with open surgery, were deemed to be candidates for endovascular repair and were treated as follows: (1) cannulation of the right Common Femoral Artery with a selective arteriogram of the right renal artery, (2) covered stent to dominant hilar artery branch, and (3) coil embolization of the remaining branches/tributaries. Perioperative outcomes and quality measures were analyzed and compared. Results: The aneurysms were successfully covered and excluded as confirmed by a completion arteriogram. There were no perioperative morbidities (ie, acute kidney injury, endoleak, etc), and all 3 patients were discharged home the same days of their interventions. At their follow-up visits, the patients were free of symptoms and had normal renal functions as well as Computed tomography angiography (CTA) confirming successfully excluded aneurysms and no endoleaks. Conclusion: The technique we used demonstrated excellent outcomes with minimal comorbidities and preservation of renal function. As with many endovascular interventions, our technique compared favorably to traditional open technique in terms of technical feasibility, decreased length of stay, faster recovery, maintaining renal function, and reduced complication rates.