title: Management and outcomes of isolated renal artery aneurysms in the endovascular era.
abstract: OBJECTIVE
  Isolated renal artery aneurysms are rare, and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on selection of patients and outcomes of renal artery aneurysms.
  
  
  METHODS
  We identified all patients undergoing open or endovascular repair of isolated renal artery aneurysms in the Nationwide Inpatient Sample from 1988 to 2011 for epidemiologic analysis. Elective cases were selected from the period 2000 to 2011 to create comparable cohorts for outcome comparison. We identified all patients with a primary diagnosis of renal artery aneurysms undergoing open surgery (reconstruction or nephrectomy) or endovascular repair (coil or stent). Patients with concomitant aortic aneurysms or dissections were excluded. We evaluated patient characteristics, management, and in-hospital outcomes for open and endovascular repair, and we examined changes in management and outcomes over time.
  
  
  RESULTS
  We identified 6234 renal artery aneurysm repairs between 1988 and 2011. Total repairs increased after the introduction of endovascular repair (8.4 in 1988 to 13.8 in 2011 per 10 million U.S. population; P = .03). Endovascular repair increased from 0 in 1988 to 6.4 in 2011 per 10 million U.S. population (P < .0001). However, there was no concomitant decrease in open surgery (5.5 in 1988 to 7.4 in 2011 per 10 million U.S. population; P = .28). From 2000 to 2011, there were 1627 open and 1082 endovascular elective repairs. Patients undergoing endovascular repair were more likely to have a history of coronary artery disease (18% vs 11%; P < .001), prior myocardial infarction (5.2% vs 1.8%; P < .001), and renal failure (7.7% vs 3.3%; P < .001). In-hospital mortality was 1.8% for endovascular repair, 0.9% for open reconstruction (P = .037), and 5.4% for nephrectomy (P < .001 compared with all revascularization). Complication rates were 12.4% for open repair vs 10.5% for endovascular repair (P = .134), including more cardiac (2.2% vs 0.6%; P = .001) and peripheral vascular complications (0.6% vs 0.0%; P = .014) with open repair. Open repair had a longer length of stay (6.0 vs 4.6 days; P < .001). After adjustment for other predictors of mortality, including age (odds ratio [OR], 1.05 per decade; 95% confidence interval [CI], 1.0-1.1; P = .001), heart failure (OR, 7.0; 95% CI, 3.1-16.0; P < .001), and dysrhythmia (OR, 5.9; 95% CI, 2.0-16.8; P = .005), endovascular repair was still not protective (OR, 1.6; 95% CI, 0.8-3.2; P = .145).
  
  
  CONCLUSIONS
  More renal artery aneurysms are being treated with the advent of endovascular techniques, without a reduction in operative mortality or a reduction in open surgery. Indications for repair of renal artery aneurysms should be re-evaluated.
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Dominique B
authors.initials: DB
authors.lastname: Buck
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: Thomas
authors.initials: T
authors.lastname: Curran
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: John C
authors.initials: JC
authors.lastname: McCallum
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Darling
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: Rishi
authors.initials: R
authors.lastname: Mamtani
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address: mscherme@bidmc.harvard.edu.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
mesh_terms: D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends