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New technology of endovascular occlusion of renal artery aneurysm (case report)

Abstract

Background. Renal artery aneurysms are treated using roentgen endovascular methods, open and hybrid operative interventions. Therapeutic decision-making depends on hospital’s equipment, vascular anatomy, patient’s age, further prognosis of the disease, and concomitant pathology. However, there are situations being serious challenges for both endovascular and open reconstructive surgery of renal arteries. In some cases, nephrectomy is considered to be the only option of preventing life-threatening bleeding in a ruptured aneurysm.

Objective. The study was aimed at demonstrating possibilities of endovascular surgery in treatment of a renal artery aneurysm, previously recognized as inoperable.

Patients and methods. A 61-year-old male patient was admitted to our Clinic presenting with events of acute intestinal obstruction. The examination revealed a large intestine tumor, as well as a renal artery aneurysm measuring 34 cm in diameter with a non-differentiated neck and second-order arteries originating from the aneurysmal cavity. The first stage was double-barreled loop sigmoidostomy was urgently performed because of acute intestinal obstruction, with the second stage being embolization of the aneurysm according to an original technique: after filling the aneurysmal cavity with spirals, coronary stents were inserted and expanded to create tunnels in the spiral-filled cavities.

Results. The kidney was preserved, with no data on of renal infarction in either early or medium-term period.

Conclusion. Stent-assisted endovascular embolization with preservation of branches is an effective organ-sparing minimally invasive method of treatment of a renal artery aneurysm of complex localization.

Keywords:nephrectomy; endovascular embolization; aneurysm; renal arteries; stenting; new techniques of embolization

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflict of interest.

Authors’ contribution. Study conception and design – Agarkov M.V.; data collection and handling – Safuanov A.A., Safuanova O.S.; statistical processing – Khilchuk A.A.; draft manuscript preparation – Agarkov M.V., Evreeva S.T.; manuscript revision – Agarkov M.V., Gertsog O.B., Popov V.V.

For citation: Agarkov M.V., Safuanov A.A., Evreeva S.T., Gertsog O.B., Safuanova O.S., Popov V.V., Khilchuk A.A. New technology of endovascular occlusion of renal artery aneurysm (case report). Angiology and Vascular Surgery. 2022; 28 (4): 81–7. DOI: https://doi.org/10.33029/1027-6661-2022-28-4-81-87 (in Russian)

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Akchurin Renat Suleymanovich

Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Deputy General Director for Surgery, Head of the Department of Cardiovascular Surgery, National Medical Research Center for Cardiology named after Academician E.I. Chazov, President of the Russian Society of Angiologists and Vascular Surgeons

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.