Hageman J H, Smith R F, Szilagyi E, Elliott J P
Surgery. 1978 Oct;84(4):563-72.
The clinical course of 29 patients bearing 36 renal artery aneurysms was reviewed. The majority of the lesions (30 of 36 or 83%) were detected incidentally in the course of angiographic examination, mostly in the study of peripheral atherosclerotic arterial disease. Twenty-five lesions 2.0 cm or less in diameter, treated conservatively and observed during a period of time of from 1 to 17 years, remained clinically silent. In 10 patients (with 11 lesions) surgical treatment was employed. For eight patients the surgical treatment consisted of reconstructive excision and repair, with excellent results in all cases but one for a period of observation of from 1 to 17 years. In one patient aneurysmal dilatation of a vein bypass graft resulted in nephrectomy 2 years following operation. In the remaining two patients nephrectomy was required. Unless hypertension or pregnancy complicates the clinical picture, renal arterial aneurysms 1.5 cm or less in diameter can be observed safely by periodic angiography. Surgical repair of an aneurysm is recommended regardless of size if pregnancy cannot be avoided and hypertension is uncontrolled, and in aneurysms 1.5 cm or less in diameter which show an increase in size. A number of reconstructive vascular procedures have proved successful. Ex vivo repair may be an organ-saving technical aid.
回顾了29例患有36个肾动脉动脉瘤患者的临床病程。大多数病变（36个中的30个，即83%）是在血管造影检查过程中偶然发现的，主要是在研究外周动脉粥样硬化疾病时发现的。25个直径在2.0厘米及以下的病变，采用保守治疗并观察了1至17年，临床上一直无症状。10例患者（共11个病变）接受了手术治疗。8例患者的手术治疗包括重建性切除和修复，在1至17年的观察期内，除1例效果不佳外，其余病例效果均良好。1例患者静脉搭桥移植血管出现动脉瘤样扩张，术后2年行肾切除术。其余2例患者需要进行肾切除术。除非高血压或妊娠使临床情况复杂化，直径在1.5厘米及以下的肾动脉动脉瘤可通过定期血管造影安全观察。如果无法避免妊娠且高血压控制不佳，以及直径在1.5厘米及以下且大小增大的动脉瘤，无论大小均建议进行动脉瘤手术修复。一些重建性血管手术已证明是成功的。体外修复可能是一种挽救器官的技术辅助手段。
