Endovascular Treatment of Renal Artery Aneurysms - A Single Center Experience Based on 101 Aneurysms

Purpose: The efficacy of endovascular treatment of true RAAs depending on aneurysm type and size.

Material and Methods: 86 patients were treated, 59 (68,60%) women and 27 (31,40%) men. In the group of 101 aneurysms treated in endovascular manner, aneurysms of different sizes occurred. Based on the data from angiographic imaging, the author’s own classification of RAAs was established depending on aneurysm localization and anatomy. Based on the localization, RAAs were divided into truncal (Type a) and bifurcation aneurysms (Type b). Based on the morphologic features, RAAs were classified as narrow neck saccular (Type 1), wide neck saccular (Type 2) and fusiform shaped (Type 3).
Truncal, narrow neck saccular RAAs (Type 1a) were treated with cover stent (stentgraft) implantation or with embolization coils (coiling). Truncal, wide neck saccular RAAs (Type 2a) were treated with cover stent (stentgraft) implantation or with emobolization coils and assisting implantation of self-expanding stent (stent assisted coiling). Bifurcation, narrow neck saccular RAAs (Type 1b) were treated in most cases with embolization coils only (coiling). Bifurcation, wide neck saccular RAAs (Type 2b) were treated with stent assisted coiling or stent assisted coiling using two self-expanding stents implanted in a Y-configuration (Y-stenting technique) to secure patency of the arteries during the introduction of embolization coils to the aneurysm sac. Fusiform RAAs (Type 3) with arteries branching off the aneurysm were treated with embolization coils and assisting implantation of self-expanding stent (stent assisting coils) or two self-expanding stents implanted in a Y-configuration (Y-stenting technique).

Results: The assessment of efficacy of the endovascular treatment was determined based on different type of imaging examinations performed within one to four months after the intervention: DSA, MR and DUS. Good clinical outcome determined as an effective embolization of the aneurysm, i.e. complete aneurysm occlusion with preserved patency of main renal artery and all segmental arteries was achieved in 87.32% cases.

Conclusions: Endovascular treatment of renal artery aneurysms is technically challenging, but valid treatment options and alternative to surgery in experienced centers with a high patient load.