Current treatment of renal artery aneurysms may be too aggressive.
OBJECTIVE
Most studies recommend repair of renal artery aneurysms (RAAs) >2 cm in diameter in asymptomatic patients, but other studies have suggested that their natural history may be more benign. We hypothesized that rupture and death in patients with asymptomatic RAAs is low and that current recommendations for RAA treatment at 2 cm may be too aggressive.


METHODS
Retrospective review of all RAAs treated at a tertiary care medical center from 2002 to 2012.


RESULTS
Fifty-nine RAA were identified in 40 patients (mean age at diagnosis, 56 years; male:female ratio, 17:23); 31 were saccular, 8 were fusiform, and 5 were bilobed. Twenty-nine patients were asymptomatic; the remainder of patients presented with hematuria (n = 4), abdominal pain (n = 3), difficult-to-control hypertension (n = 3), or flank pain (n = 2). Aneurysm location included the main renal artery bifurcation (n = 35), main trunk (n = 7), primary branch (n = 6), pole artery (n = 6), and secondary branch (n = 1). Operative management of RAAs included vein patch (n = 6), prosthetic patch (n = 4), primary repair (n = 3), plication (n = 1), patch and implantation (n = 1), and ex vivo repair (n = 1). Eight asymptomatic RAAs were treated surgically (mean RAA diameter = 2.4 ± 0.1 cm, range, 2-3 cm), with the remaining 33 asymptomatic RAAs being managed conservatively (mean RAA diameter = 1.4 ± 0.1 cm, range, 0.6-2.6 cm). Mean hospital length of stay was 4 days, with no late postoperative complications and 0% mortality. Non-operated patients were followed for a mean of 36 ± 9 months, with no late acute complications and 0% mortality. Mean RAA growth rate of patients with multiple imaging studies was 0.60 ± 0.16 mm/y.


CONCLUSIONS
The rate of aneurysm rupture and death in our untreated RAA patients is zero, the growth rate is 0.60 ± 0.16 mm/y, and there were no adverse outcomes in asymptomatic RAAs >2 cm that were observed. We may currently be too aggressive in treating asymptomatic RAAs.
Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif.
Jill Q
JQ
Klausner
Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif.
Michael P
MP
Harlander-Locke
Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif.
Adam N
AN
Plotnik
Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif.
Evan
E
Lehrman
Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif.
Brian G
BG
DeRubertis
Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif. Electronic address: pflawrence@mednet.ucla.edu.
Peter F
PF
Lawrence
D015746:Abdominal Pain / Q000209:etiology; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000209:etiology; D058070:Asymptomatic Diseases; D015897:Comorbidity; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000592:standards; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000592:standards