Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
J Vasc Surg. 2014 Aug;60(2):448-52. doi: 10.1016/j.jvs.2014.03.006. Epub 2014 Apr 16.
Renal artery aneurysms (RAAs) are uncommon, and rates of growth and rupture are unknown. Limited evidence therefore exists to guide clinical management of RAAs, particularly small aneurysms that are asymptomatic. To further characterize the natural history of RAAs, we studied anatomic characteristics and changes in diameter during imaging surveillance.
Patients evaluated for native RAAs at a single institution during a 5-year period (July 2008 to July 2013) were identified and analyzed retrospectively. Patients with two or more cross-sectional imaging studies (computed tomography or magnetic resonance imaging) more than 1 month apart were included. Demographic and clinical data were collected from medical records, and anatomic data (including aneurysm diameter, calcification, and location) were obtained from electronic images. Changes in RAA diameters over time were evaluated by plots and Wilcoxon signed rank tests.
Sixty-eight RAAs in 55 patients were analyzed. Median follow-up was 19.4 months (interquartile range, 11.2-49.0 months). Mean age at presentation was 61.8 ± 9.8 years, and 73% of patients were women. Hypertension was prevalent among 73% of patients. Multiple RAAs were present in 18% of patients, and 24% also had arterial aneurysms of other splanchnic or iliac vessels. The majority of RAAs were calcified and located at the main renal artery bifurcation. Mean initial aneurysm diameter was 16.0 ± 6.4 mm. Median annualized growth rate was 0.06 mm (interquartile range, -0.07 to 0.33 mm; P = .11). No RAA ruptures or acute symptoms occurred during surveillance, and 10.3% of RAAs were repaired electively.
Risk of short-term RAA growth or rupture was low. These findings suggest that annual (or less frequent) imaging surveillance is safe in the majority of patients and do not support pre-emptive repair of asymptomatic, small-diameter RAAs.
肾动脉动脉瘤（RAA）较为罕见，其生长和破裂的速度尚不清楚。因此，目前的证据还不足以指导 RAA 的临床管理，特别是对于无症状的小动脉瘤。为了进一步了解 RAA 的自然病史，我们研究了在影像学监测期间的解剖学特征和直径变化。
在一个机构中，对 5 年内（2008 年 7 月至 2013 年 7 月）评估的 RAA 患者进行回顾性分析。纳入至少有两次相隔超过 1 个月的横断面成像研究（计算机断层扫描或磁共振成像）的患者。从病历中收集人口统计学和临床数据，并从电子图像中获取解剖学数据（包括动脉瘤直径、钙化和位置）。通过绘图和 Wilcoxon 符号秩检验评估 RAA 直径随时间的变化。
共分析了 55 例患者的 68 个 RAA。中位随访时间为 19.4 个月（四分位距，11.2-49.0 个月）。就诊时的平均年龄为 61.8±9.8 岁，73%的患者为女性。73%的患者患有高血压。18%的患者存在多个 RAA，24%的患者还存在其他内脏或髂血管的动脉瘤。大多数 RAA 存在钙化，位于主肾动脉分叉处。初始动脉瘤直径平均为 16.0±6.4mm。平均年增长率为 0.06mm（四分位距，-0.07 至 0.33mm；P=0.11）。在监测期间未发生 RAA 破裂或急性症状，有 10.3%的 RAA 选择性修复。
短期内 RAA 生长或破裂的风险较低。这些发现表明，在大多数患者中，每年（或更不频繁）的影像学监测是安全的，并且不支持对无症状、小直径的 RAA 进行预防性修复。
