Heidi J Miller, MD, MPH, Rashad G Choudry, MD, Radi Zaki, MD. Albert Einstein Healthcare Network.
We present a 63 year old healthy man with hypertension, who was evaluated for hematuria, at which time a 2.8 cm renal artery aneurysm (RAA) was identified by CT angiography. An unrelated bladder mass was discovered to be the cause of the hematuria.
A diagnostic angiogram to evaluate the potential for endovascular treatment by coiling or stenting was performed. The aneurysm was found to be amenable for coiling, however given the extensive involvement of the vessels feeding the upper pole of the kidney, it was felt this would potentially be a large functional sacrifice. A nuclear renal scan (MAG3) confirmed equal right and left renal function. The option of nephrectomy as means of treating the aneurysm was discussed with the patient, however he opted for renal salvage. We performed a laparoscopic hand-assisted nephrectomy with extracorporeal aneurysmectomy and right renal autotransplantation through the same incision. The complex back-table reconstruction included arterial reconstruction by excising the mouth of the aneurysm and anastomosing the transected superior pole artery into the main renal artery, thus maintaining blood flow to all renal artery branches. The right renal vein was anastomosed to the right iliac vein similar to standard renal transplantation technique in the right iliac fossa, and the reconstructed artery was anastomosed to the right external iliac artery in a fashion similar to an IVC patch. The ureter was anastomosed directly to the bladder over a temporary ureteral stent.
The patient was discharged on post-operative day four. On follow up evaluation, he was pain free with normal serum creatinine and a renal duplex ultrasound confirming stenosis-free patency of the renal vessels and good flow to the renal parenchyma.
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