[Thrombosed aneurysm of a segmental renal artery branch. Diagnostic and therapeutic approach].

INTRODUCTION

We present the case of a 37-year-old man with a thrombosed aneurysm of a segmental branch of the left renal artery, which was diagnosed after a radiological investigation for colic-like pain, and treated conservatively with endovascular approach.

MATERIALS AND METHODS

After repeated episodes of colic-like pain in his left side with normal ultrasound of the urinary tract, A.R. (37 years old) undergoes a CT urogram of the abdomen, which shows a complete thrombosis of the middle third of the left renal artery, which is associated with hypoperfusion of the lower middle third of the kidney with suspected ischemia of the lower pole. In confirmation of the previous clinical scenario, we proceed with a urgent angiography, which identifies a pseudo-aneurysm, partially thrombosed, of the segmental branch of the left renal artery at the lower middle pole. During the hospitalization, the clinical picture is complicated by an unstable arterial hypertension associated with headache and nausea. A renal scintigraphy confirms a severe impairment of the renal function mainly at the level of the middle third of the lower left kidney. The total glomerular filtration rate sec. Gates was equal to 64.3 mL/min with a percentage breakdown of the global renal function of 28% to the right and 72% to the left. The location of the vascular defect argues for endovascular intervention in the attempt to preserve the remaining renal parenchyma. We proceed with a standard angiography with selective access to the left renal artery with a catheter via femoral artery Cobra 5Fx80 TERUSMO cm. The tortuosity of the thrombus and the angle of the aneurysm site prevent, despite several attempts, the passage of the guide wire for a possible stenting and fibrinolysis. We opt for the placement of 5 spirals at the aneurysm (Boston Soft GDC-10 SR 360 7mm x 15cm), in order to preserve the residual parenchyma, excluding the aneurysmal artery at risk of rupture and extent of the thrombus.

RESULTS

Immediately after the procedure, the clinical picture remained stable with complete remission of painful symptoms and with a good blood pressure control. At about 6 months, the renal scintigraphy shows a filtered global impairment of 70%, 30% for the left kidney, a slight improvement over the previous controls. The blood pressure remains within the limits with amlodipine 5 mg.

CONCLUSIONS

Renal artery aneurysms are uncommon and occur in approximately 0.09% of the general population. The etiopathogenesis at a young age is often dysplastic in nature and the diagnosis is made incidentally or during evaluation of related symptoms, being asymptomatic until they become complicated. Their treatment is proposed to prevent complications such as rupture or thrombosis. Given the extreme variability of presentation, the surgical technique, traditional or endoscopic, is at the surgeon's discretion. In our case, we opted for a conservative approach since the degree of renal parenchyma impairment and the patient's hemodynamic condition allowed to.