Management of a complex renal artery aneurysm
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1 Management of a complex renal artery Pedro Pinto Sousa 1 ; Arlindo Matos 2 ; Carlos Veiga 2 ; Rui Almeida 2 ; Pedro Sa Pinto Centro Hospitalar Vila Nova de 2 - Centro Hospitalar do Porto
2 Disclosure Speaker name:... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Introduction Renal artery (RAA) is a rare entity with a prevalence of 0,09% in general population, being it the second most frequent visceral More frequent in the 6 th decade of life, affecting predominantly women Most of the RAA are diagnosed incidentally (asymptomatic) When with symptoms: Flanck pain, abdominal pain, hematuria, refractary hypertension Renal bruit and abdominal palpable mass are not realiable Poutasse classification: Type I saccular Type 2 - fusiform Type 3 - desiccant Type 4 hilum or parenchymatous
4 Introduction Diagnosis: angiotc (GOLD STANDARD) angiormn ecodoppler Angiography Indications to treat: > 20mm, female gender in childbearing age Symptomatic Associated with renal artery stenosis, thromboembolism, dissection or rupture Treatment options Rundback classification Type I RA trunk -> endovascular Type II evolving the RA bifurcation -> open surgery or endovascular Type III hilum or parenchymatous -> open surgery, sometimes requiring ex-vivo reconstruction
5 Case Report 71-year-old Personal history: - Hypertension > twenty years Normal Renal function Following the study for an abdominal discomfort Complex RAA was incidentally diagnosed CT angiography (three-dimensional reconstruction): 13mm, saccular located at the right renal hilum.
6 Case Report Laparoscopic nephrectomy with ex vivo repair of the RAA. Aneurysm was resected Polar renal artery was implanted over the resected area with a latero-terminal anastomosis.
7 Case Report Renal vein was augmented with a spiral great saphenous vein graft Kidney was implanted into the right iliac fossa.
8 Case Report The intervention and postoperative course were uneventful. Ultrasound (day after procedure): normal renal perfusion with normal flow indices. Actual follow-up (six months after surgery) Patient is alive with a well-functioning auto-transplant (normal renal perfusion scintigraphy)
9 Discussion RAA may be nowadays more frequently diagnosed due to the increasing use of imaging techniques. We present here a complex Poutasse Type IV and Rundback Type III RAA Ex vivo repair and auto-transplantation is a challenging but feasible option for treating hilum RAA with multiple technical solutions availables, especially in a Vascular Surgery department with a vast experience in conventional renal transplant
10 Management of a complex renal artery Thank You!! Pedro Pinto Sousa 1 ; Arlindo Matos 2 ; Carlos Veiga 2 ; Rui Almeida 2 ; Pedro Sa Pinto Centro Hospitalar Vila Nova de 2 - Centro Hospitalar do Porto
11 Management of a complex renal artery Pedro Pinto Sousa 1 ; Arlindo Matos 2 ; Carlos Veiga 2 ; Rui Almeida 2 ; Pedro Sa Pinto Centro Hospitalar Vila Nova de 2 - Centro Hospitalar do Porto
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