Nierenarterienaneurysma

Verkalktes,
teilthrombosiertes Aneurysma der linken Nierenarterie im Hilusbereich
Wikipedia • CC BY-SA 4.0
Fibromuscular
dysplasia • Fibromuscular dysplasia - involving renal arteries with aneurysm formation - Ganzer Fall bei Radiopaedia
Knipe, H. Fibromuscular dysplasia - involving renal arteries with aneurysm formation. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-53111 • CC by-nc-sa 3.0 (modified)
Endovascular
treatment of incidental renal artery aneurysm. Posterosuperior view of 3D Reconstructed image of both kidneys with renal vasculature, where the saccular aneurysm can be seen arising from the branching point of the left renal artery.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
treatment of incidental renal artery aneurysm. Posterior view of 3D Reconstructed image of both kidneys with renal vasculature, where the saccular aneurysm can be seen arising from the branching point of the left renal artery.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
treatment of incidental renal artery aneurysm. Posterior view of 3D Reconstructed image of both kidneys with renal vasculature, where the saccular aneurysm can be seen arising from the branching point of the left renal artery.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
treatment of incidental renal artery aneurysm. Anterior view of 3D Reconstructed image of both kidneys with renal vasculature, where the left renal artery aneurysm can be observed.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
treatment of incidental renal artery aneurysm. 3D Reconstructed image of the left renal artery aneurysm and abdominal vasculature.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
treatment of incidental renal artery aneurysm. Coronal CT in arterial phase shows left renal artery aneurysm.
www.eurorad.org • CC by-nc-sa-4.0
Aneurysma der
rechten Nierenarterie in der Aufzweigung im Hilus.
Wikipedia • CC BY-SA 4.0
Endovascular
treatment of incidental renal artery aneurysm. Axial CT in arterial phase shows a focal dilatation of the renal artery presenting the same enhancement as the aorta, compatible with left renal artery aneurysm.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
treatment of incidental renal artery aneurysm. Axial CT in arterial phase shows a focal dilatation of the renal artery presenting the same enhancement as the aorta, compatible with left renal artery aneurysm.
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
intervention in renovascular disease: a pictorial review. Axial CT (a, long white arrow) and angiographic (b, black arrow) images of a left intraparenchymal renal artery pseudoaneurysm subsequent to partial nephrectomy for renal tumour. The propensity for severe haemorrhage with these lesions warranted selective coil embolisation (c, white arrow)
insightsimaging.springeropen.com • Open Access
Endovascular
intervention in renovascular disease: a pictorial review. A true extraparenchymal saccular right renal artery aneurysm seen on MR (a, long white arrow) and angiography (b, black arrow) effectively managed with intraaneurysmal coil embolisation (c, white arrow)
insightsimaging.springeropen.com • Open Access
Endovascular
treatment of incidental renal artery aneurysm. The angiogram shows the aneurysm arising from the branching point of the left main renal artery (MRA).
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Renal artery aneurysms (RAA) are considered the second most common visceral aneurysm (15-22%), most common being splenic artery aneurysm (60%).

Epidemiology

RAAs occur in ~0.1% of the population . They are more common in females  with a median age of diagnosis of 50 years .

Clinical presentation

Most cases are asymptomatic. Symptoms usually arise from rupture of an aneurysm, embolization of peripheral vascular bed or arterial thrombosis. Hypertension is associated with ~75% of cases of these aneurysms. Hematuria has also been reported in many cases.

Pathology

Approximately 20% of cases are bilateral. Mostly, the aneurysms are saccular and tend to occur at the bifurcation of the main renal artery or first-order branch .

Etiology

Radiographic features

CT
  • non-contrast: soft tissue mass lesion in the region or course of renal artery
  • post-contrast: contrast-filled outpouching in the course of the renal artery
Angiography (DSA)

Aneurysms can be well detected and characterized by angiography, in terms of size, neck diameter and type.

Treatment and prognosis

Management depends on various factors like age, sex, severity of hypertension, anticipated pregnancy, and aneurysm morphology. In any young female with anticipated pregnancy, embolization or endovascular intervention is suggested. Pregnancy-associated RAA rupture is associated with 80% mortality.

Follow-up for renal artery aneurysm :

  • 1.0-1.5 cm: can be safely followed
    • follow-up in 1-2 years, as long as the patient is not premenopausal
  • >1.5 cm
    • consider surgical or endovascular repair
    • surgical treatment is recommended for aneurysms >2 cm in size

Modality of management depends on location:

  • branch RAA: embolization
  • main renal artery RAA: ligation and bypass surgery, nephrectomy or stent placement
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Nierenarterienaneurysma:
Ehlers-Danlos
syndrome
Wikipedia • CC BY 2.5
Fibromuskuläre
Dysplasie
Wikipedia • CC BY 2.0
Vaskulitis
 
Wikipedia • CC BY-SA 4.0
Marfan-Syndrom
 
pediatricimaging.org • CC-by-nc-sa 4.0
Milzarterienaneurysma
 
insightsimaging.springeropen.com • Open Access
Arteria
renalis
Wikipedia • Public domain
Embolisation
Nierenarterienaneurysma
insightsimaging.springeropen.com • Open Access