Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2401-2405
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2401
Ex vivo revascularization of renal artery aneurysms in a patient with solitary kidney: A case report
Xi-Yang Chen, Ji-Chun Zhao, Bin Huang, Ding Yuan, Yi Yang
Xi-Yang Chen, Ji-Chun Zhao, Bin Huang, Ding Yuan, Yi Yang, Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen XY reviewed the literature, contributed to manuscript drafting, and acted as first assistant in the surgical procedure; Zhao JC was the patient’s vascular surgeon and reviewed the literature; Huang B contributed to manuscript drafting and the surgical procedure; Yuan D and Yang Y were responsible for revision of the manuscript and interpreted the imaging findings; all authors gave final approval for the manuscript version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ji-Chun Zhao, MD, PhD, Professor, Department of Vascular Surgery, West China Hospital of Sichuan University, No. 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China. xgwkzjc@126.com
Telephone: +86-28-85423008 Fax: +86-28-85423008
Received: February 15, 2019
Peer-review started: February 15, 2019
First decision: May 31, 2019
Revised: June 25, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: August 26, 2019
Processing time: 192 Days and 9.8 Hours
Abstract
BACKGROUND

Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons. Ex vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases, which are not suitable for endovascular repair. The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.

CASE SUMMARY

A 39-year-old female patient presented with left lumbar pain for more than 3 mo. Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches. This patient met the criteria for surgical repair due to symptoms of threatened rupture. According to the anatomy and location of multiple RAAs, ex vivo revascularization with saphenous vein graft (SVG) was performed. At the 3-year follow-up, computed tomography angiography demonstrated the aneurysmal degeneration of the Y-shaped SVG. The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.

CONCLUSION

SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft, especially for solitary kidney patients.

Keywords: Renal artery aneurysm; Bypass; Ex vivo repair; Aneurysmal degeneration; Case report

Core tip: This rare case of complicated left renal artery aneurysms (RAAs) with absence of right kidney presented a major challenge for the surgeon. From a technical aspect, most RAAs are treated by endovascular procedures, and such complicated surgical repair could give surgeons more confidence with complex renal artery revascularization. Although saphenous vein graft is considered the first choice for auto-renal bypass graft, the risk of restenosis and aneurysmal degeneration remains unresolved. For the RAAs without evidence of inflammation, prosthetic graft may be the alternative choice for patients.