Study Evaluates Renal Artery Aneurysm Management

April 1, 2015—A study of the contemporary management of renal artery aneurysms (RAAs) was published by Jill Q. Klausner, BS, et al in the Journal of Vascular Surgery (2015;61:978–984). The specific objectives of this study were to define the clinical features of RAAs, including the precise growth rate and risk of rupture; to examine the current management and outcomes of RAA treatment using existing guidelines; and to examine the appropriateness of current criteria for repair of asymptomatic RAAs.

In the study, a standardized multi-institutional approach was used to evaluate patients with RAAs at institutions from all regions of the United States. Patient demographics, aneurysm characteristics, aneurysm imaging, conservative and operative management, postoperative complications, and follow-up data were collected.

The investigators concluded that this large contemporary multi-institutional study demonstrated that asymptomatic RAAs rarely rupture (even when > 2 cm), growth rate is 0.086 ± 0.08 cm/y, and calcification does not protect against enlargement. The study found that RAA open repair is associated with significant minor morbidity, but rarely a major morbidity or mortality. Additionally, aneurysm repair cured or improved hypertension in > 50% of patients whose RAA was identified during the workup for difficult-to-control hypertension, reported the investigators in the Journal of Vascular Surgery.

As summarized in the Journal of Vascular Surgery, the investigators identified a total of 865 RAAs in 760 patients at 16 institutions. Of these patients, 75% were asymptomatic; symptomatic patients had difficult-to-control hypertension (10%), flank pain (6%), hematuria (4%), and abdominal pain (2%). The RAAs had a mean maximum diameter of 1.5 ± 0.1 cm. Most were unilateral (96%), on the right side (61%), saccular (87%), and calcified (56%).

Elective repair was performed in 213 patients with 241 RAAs, usually for symptoms or size > 2 cm; the remaining 547 patients with 624 RAAs were observed. Major operative complications occurred in 10% of patients, including multisystem organ failure, myocardial infarction, and renal failure requiring dialysis.

RAA repair for difficult-to-control hypertension cured 32% of patients and improved it in 26%. Three patients had ruptured RAAs; all were transferred from other hospitals and underwent emergency repair, with no deaths. Conservatively treated patients were monitored for a mean of 49 months, with no acute complications. Aneurysm growth rate was 0.086 cm/y, with no difference between calcified and noncalcified aneurysms, noted the investigators in the Journal of Vascular Surgery.