Modified Ex-vivo Renal Bypass For Hilar Renal Artery Aneurysm
Samuel D. Leonard, MD, Mitchell George, MD, Laura Ocasio, MD, Thanila Macedo, MD, Naveed Saqib, MD, Gustavo Oderich, MD.
McGovern Medical School at UTHealth, Houston, TX, USA.
We report a 65-year-old female patient who presented with multiple renal artery aneurysms including a symptomatic 3.7cm renal artery hilar aneurysm. The patient's medical history was notable for well controlled hypertension and normal renal function. Pre-operative computed tomography angiography (CTA) demonstrated a right sided 3.7cm calcified saccular renal artery aneurysm affecting the hilum of the renal artery with a separate 6mm aneurysm in the right anterior division branch and a 5mm saccular aneurysm in a left renal artery branch. The patient's right renal artery aneurysm was treated using open surgical approach via right subcostal incision with modified ex-vivo technique. The right kidney was left in situ after isolation of the renal artery, vein and ureter. Renal cooling was performed using cold renal perfusate via the right renal artery with clamping of the renal vein and a small venotomy to allow clearance of the perfusate. The right renal artery aneurysm was opened and separate branch renal artery reconstruction was performed with bifurcated saphenous vein bypass. The small branch aneurysm was plicated using bovine pericardial patch (Figure). Completion intraoperative renal artery duplex ultrasound revealed no technical defects. The patient recovered without complications and remains asymptomatic at 6-months follow up. A CTA demonstrated widely patent renal reconstruction with no change in diameter in the small contra-lateral renal aneurysm.
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