BILATERAL KIDNEY AUTOTRANSPLANTATION AS A SOLUTION FOR MULTIPLE ANEURYSMS OF THE RENAL ARTERIES BRANCHES: A CASE REPORT

Abstract

Introduction: Renal artery aneurysms are rare clinical entities whose treatment criteria are not fully established. Endovascular treatment has gained acceptance in the case of renal artery trunk aneurysms. However, in the case of aneurysms of the renal artery branches, such procedures are often impossible due to high morbidity, so the question remains about the best treatment modality. We present a clinical case of multiple bilateral aneurysms of the renal artery branches in a young patient adequately treated with ex-vivo reconstruction and renal autotransplantation. Case-presentation: A 35-year-old woman was diagnosed with bilateral renal artery aneurysms during an investigation of secondary arterial hypertension (AHT). The patient underwent surgical treatment with renal autotransplantation, and the right kidney was initially treated. Transperitoneal laparoscopic nephrectomy was performed. She underwent ex vivo repair of aneurysms, on the bench, with aneurysmectomy and aneurysmorrhaphy. The graft was implanted in the right iliac fossa with anastomoses to the external iliac artery and vein. After three months, an identical procedure was performed on the left. Upon inspection, a large aneurysm was observed in the renal artery bifurcation and another small aneurysm in one of the branches; both corrected with aneurysmec- tomy and aneurysmorrhaphy. Ex-vivo angiographic control ensured the preservation of graft arteries patency without evidence of residual aneurysms. The kidney was implanted in the left external iliac vessels uneventfully. A study with renal scintigraphy confirmed the adequate function of both kidneys. The patient is asymptomatic at nine months of follow-up with serum creatinine and glomerular filtration rate within normal values. Conclusion: Renal autotransplantation with ex vivo arterial repair seems to be a good solution in treating aneurysms of the renal artery, particularly in complex cases with multiple aneurysms.

Keywords

• Ex vivo renal artery repair
• Hypertension
• Renal artery aneurysm
• Kidney transplantation
• Renal autotransplantation