Dzsinich C, Gloviczki P, McKusick M A, Pairolero P C, Bower T C, Hallett J W, Cherry K J
Division of Vascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905.
Cardiovasc Surg. 1993 Jun;1(3):243-7.
Between 1978 and 1990, 32 patients (15 men and 17 women; mean age 48 (range 15-83) years) underwent 35 operations for renal artery aneurysm (4.2% of 829 renal artery repairs). Eleven patients presented with acute symptoms (nine with hematuria, eight with abdominal pain, two with acute hypertension). Twenty-eight of the 32 patients had chronic hypertension. The diagnosis was confirmed by angiography in all but two. The mean diameter of the renal artery aneurysm was 1.7 (range 0.7-9.0) cm. Seventeen patients had concomitant renal artery stenosis; none of the aneurysms ruptured. Nephrectomy was performed in seven patients and excision of the aneurysm without reconstruction in five. Twenty patients underwent 23 reconstructions using lateral suture (three procedures), vein patch (three), saphenous vein (13), Dacron (three) or composite (vein and hypogastric artery) graft (one). Seven patients underwent ex vivo renal artery repair. There was no perioperative death or secondary nephrectomy. One postoperative graft occlusion was successfully revised. Hypertension improved in 50% of patients. The presence of hypertension, enlargement of a renal artery aneurysm, solitary kidney, bilateral involvement, acute hematuria or potential loss of kidney or renal function may be indications for surgical treatment of an aneurysm > 1.5 cm in diameter. A renal artery aneurysm of any size should be repaired in women who may become pregnant. Where there is branch involvement, ex vivo repair is the procedure of choice for renal salvage.
1978年至1990年间，32例患者（15例男性和17例女性；平均年龄48岁（范围15 - 83岁））接受了35次肾动脉动脉瘤手术（占829例肾动脉修复手术的4.2%）。11例患者出现急性症状（9例血尿、8例腹痛、2例急性高血压）。32例患者中有28例患有慢性高血压。除2例患者外，其余均通过血管造影确诊。肾动脉动脉瘤的平均直径为1.7 cm（范围0.7 - 9.0 cm）。17例患者伴有肾动脉狭窄；无一例动脉瘤破裂。7例患者接受了肾切除术，5例患者进行了动脉瘤切除但未重建。20例患者使用侧方缝合（3例）、静脉补片（3例）、大隐静脉（13例）、涤纶（3例）或复合（静脉和腹下动脉）移植物（1例）进行了23次重建。7例患者接受了离体肾动脉修复。无围手术期死亡或二次肾切除。1例术后移植物闭塞成功修复。50%的患者高血压情况有所改善。高血压、肾动脉动脉瘤增大、孤立肾、双侧受累、急性血尿或可能丧失肾脏或肾功能可能是直径>1.5 cm动脉瘤手术治疗的指征。对于可能怀孕的女性，任何大小的肾动脉动脉瘤都应进行修复。当存在分支受累时，离体修复是挽救肾脏的首选方法。
