TREATMENT OF BILATERAL COMPLEX BILATERAL ANEURYSMS OF THE RENAL ARTERY BY EX-VIVO SURGERY AND AUTOTRANSPLANTATION IN THE ILIAC FOSSA. ANALYSIS OF OUR EXPERIENCE FROM 1/2010 TO 12/2018
Objective: To analyze the experience in the treatment of bilateral complex arterial aneurysms of the renal artery
Introduction: Renal artery aneurysms are a rare clinical entity and the epidemiology, pathophysiology and best treatment are not clearly defined in the literature.
Material and Methods: Retrospective analysis of the database of patients with the diagnosis of renal artery aneurysms. A total of 3 patients with bilateral aneurysms were surgically treated and a descriptive analysis was applied on a case-by-case basis.
Clinical case 1: A 46-year-old female patient with arterial hypertension with incidental diagnosis of two saccular aneurysms of the right renal artery and two saccular aneurysms of the left renal artery. A left nephrectomy was performed laparoscopically and an aneurysmectomy and angioplasty with internal saphenous vein and kidney implant were performed in the left iliac fossa. Four months later, the right kidney was treated with laparoscopic nephrectomy, aneurysmorrhaphy associated with aneurysmectomy and bypass with internal saphenous vein, renal vein extension with internal saphenous vein spiral prosthesis and implantation of the kidney in the right iliac fossa.
Case report 2: Female patient, 38 years old, arterial hypertension with incidental diagnosis of two saccular aneurysms of the right and left renal arteries. A left nephrectomy was performed laparoscopically and the aneurysms were excluded with Yasergil titanium clips associated with aneurismorrhaphy and left iliac fossa implant. Four months later, a right laparoscopic nephrectomy was performed and aneurysms were treated with aneurysmorrhaphy and renal vein extension, with spiral vein prosthesis of the internal saphenous vein, and implantation in the right iliac fossa.
Clinical case 3: A 33-year-old male patient with the incidental diagnosis of two fusiform aneurysms of the right renal artery and two saccular aneurysms of the left renal artery. A right nephrectomy was performed laparoscopically, and the renal polar artery was ligated because of the impossibility of reconstruction and the kidney was implanted in the right iliac fossa. Seventeen months later, a left nephrectomy was performed laparoscopically and aneurysmectomy was performed in association with two renal bypasses with internal saphenous vein and implantation of the kidney in the left iliac fossa.
Discussion and conclusion: The treatment of bilateral aneurysms is rare and, in 2014, the first case of autotransplant treatment was published. There are, however, no randomized trials comparing in situ, ex vivo and endovascular surgery. At our center, the treatment of complex renal artery aneurysms, which we defined as those requiring greater than 45 minutes of renal artery clamping time or located in artery areas not accessible to in situ reconstruction, is performed through ex-vivo surgery and autotransplantation in the iliac fossa. This therapy represents an excellent option with zero morbidity and mortality. Experience in renal transplantation and vascular surgery is a key requirement for successful treatment.
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