Renal Artery Aneurysm Repair

A 51 year old hispanic male present to the emergency department complaining of right flank pain and hematuria. His past medical history is significant for hypertension and hypercholesterolemia for which he has been taking hyzaar, lipitor and aspirin. The physical examination revealed a soft abdomen, no tenderness, no palpable mass, no bruit. His laboratories exams were essentially normal except for red blood cells in urine.

A CT of abdomen and pelvis a 1.5 cm right renal artery aneurysm involving the branches (Fig 1 and 2).

Fig 1. Right renal artery aneurysm.	Fig 2. Right renal artery aneurysm involving segmental branches.

In the presence of a symptomatic renal artery aneurysm the patient was taken to the operating room and through a right flank transverse incision the right kidney and hilum were exposed, the aneurysm was identified and dissected free from the adjacent structures. The renal artery and vein were transected from the aorta and vena cava respectively and cold ischemia was achieved perfusing the kidney with Wisconsin's solution and placing it in ice. The kidney was transplanted to the iliac fosa and the hypogastric artery and vein were used as blood supply and drainage. A segment of grater saphenous vein and branches was used to reconstruct the renal artery and segmental arteries (Fig 3 and 4).

Fig 3. Renal vein and artery anastomosed to iliac vein and hypogastric artery.

Fig 4. Segment of greater saphenous vein and branches used to reconstruct the renal artery