A systematic review of endovascular management of renal artery aneurysms

Kevin P Sheahan; Imran Alam; Tugche Pehlivan; Edoardo Pasqui; Hayley Briody; Hong Kuan Kok; Hamed Asadi; Michael J Lee

doi:10.1016/j.jvir.2024.04.004

A systematic review of endovascular management of renal artery aneurysms

J Vasc Interv Radiol. 2024 Apr 14:S1051-0443(24)00276-8. doi: 10.1016/j.jvir.2024.04.004. Online ahead of print.

Authors

Kevin P Sheahan¹, Imran Alam², Tugche Pehlivan², Edoardo Pasqui³, Hayley Briody⁴, Hong Kuan Kok⁵, Hamed Asadi⁶, Michael J Lee⁴

Affiliations

¹ Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: kevinsheahan@rcsi.ie.
² Royal College of Surgeons in Ireland, Dublin, Ireland.
³ Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
⁴ Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
⁵ Interventional Radiology Service, Department of Radiology, Northern Health, 185 Cooper Street, Melbourne, Australia.
⁶ Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, VIC, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, VIC, Australia.

PMID: 38626869
DOI: 10.1016/j.jvir.2024.04.004

Abstract

Purpose: To perform a qualitative systematic review of endovascular management of renal artery aneurysms (RAA).

Materials and methods: A comprehensive electronic search of PubMed, MEDLINE, EMBASE, Google Scholar and Cochrane databases from 2000 to 2022 was performed using the search terms "renal artery," "aneurysm," AND "endovascular." Means of outcome measures were calculated with a primary endpoint focused on RAA-related mortality and rupture. Secondary end points included re-intervention rate and renal infarction.

Results: There were 454 RAAs treated in 427 patients using endovascular techniques. Mean age was 53.77 years, with a female predominance (62%). A variety of endovascular treatments of RAA were utilized with excellent technical success (96%), renal parenchymal preservation, and a low rate of moderate/severe adverse events (AE). Primary coil embolization was the most commonly used technique (44.7%). There was an overall 22.9% AE rate, 6.7% of which were moderate/severe and 0% peri-procedural mortality. The most common AE was renal infarction (49 patients, 11.5%); however, renal function was preserved in 84% of patients. Nephrectomy rate was 0.4%. CTA was the most common imaging follow-up modality utilized in 72% of studies. Only nine studies (34%) reported anticoagulant use. Although the risk of delayed aneurysm reperfusion warrants clinical and imaging surveillance, relatively few patients (3%) required re-intervention in this cohort.

Conclusion: Endovascular management of RAA is a technically feasible treatment option with low rates of adverse events and reintervention. The present study highlights the technologies available for operators, a need for standardization of AE reporting, anticoagulation therapy and follow-up imaging.

Keywords: Embolization; Endovascular; Renal Artery Aneurysm.

Publication types

Review