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Balloon-assisted coil embolization. (A) Selective renal artery angiography showing a type II RAA. (B) Balloonassisted embolization showing a basket configuration after the first GDC deployment. (C) Dense packing with aneurysm exclusion in the control angiography.
Source publication
Although renal aneurysms are considered uncommon lesions, they are being disclosed more often with the increasing use of noninvasive imaging diagnostic methods. As the natural history is poorly defined, criteria for treatment are still controversial. Because it is less invasive, the endovascular treatment of renal artery aneurysms has become prefer...
Contexts in source publication
Context 1
... pole is connected to a needle, positioned in the patient's skin. Within 1 minute the current dissolves the uninsulated stainless steel section proximal to the platinum coil by electrolysis and the delivery wire is then withdrawn. The size of the first coil should equal the aneurysm size, achieving a basket-like configuration within the sac (Fig. 3b). The remaining cavity is filled with smaller coils, which are placed within the network of the first GDC, until the whole cavity of the aneurysm is densely packed with coils (Fig. ...
Context 2
... and the delivery wire is then withdrawn. The size of the first coil should equal the aneurysm size, achieving a basket-like configuration within the sac (Fig. 3b). The remaining cavity is filled with smaller coils, which are placed within the network of the first GDC, until the whole cavity of the aneurysm is densely packed with coils (Fig. ...
Context 3
... to test the stability of the coil. If no displacement of the coil is observed, the coil is detached. If movement is detected after balloon deflation, the coil is considered unstable and repositioned or removed. The procedure is repeated to obtain a dense and stable packing. We used this technique, without complications, in two type II aneurysms (Fig. ...
Citations
... Endovascular management by selective arterial embolization (SAE), when available, is consensually preferred as the first-line treatment for iatrogenic arterial lesions after PN, as it allows the exclusion of FAAs while ensuring maximal parenchymal preservation [14,15]. In a review of 30 studies including 105 patients with FAAs after PN, SAE was the first-line treatment in 101 (96%) patients [11]. ...
The primary objective was to evaluate the clinical success rate after endovascular embolization of iatrogenic vascular lesions caused during partial nephrectomy. The secondary objective was to evaluate the technical success and to assess potential effects on renal function. We retrospectively included consecutive patients from our center who underwent selective embolization to treat iatrogenic renal arterial lesions induced during partial nephrectomy between June 2010 and June 2020. The technical and clinical success rates and renal outcomes were collected. We identified 25 patients with 47 pseudoaneurysms and nine arteriovenous fistulas. Among them, eight were treated by coils only, eight by liquid embolization agents only, and nine by both. The technical success rate was 96% after the first attempt and 100% after the second attempt. The median follow-up was 27.1 ± 24.3 months. Clinical success, defined as no need for further hemostatic surgery during follow-up, was also obtained in 96% and 100% of patients with one and two attempts, respectively. Renal function estimated by the modification of diet in renal disease equation did not change significantly despite a mean 13.8% ± 15.1% decrease in kidney functional volume estimated by angiography. No complications were attributable to the endovascular treatment. No significant difference was found across embolization agents; however, the subgroup sizes were small. Endovascular embolization is safe and effective for treating iatrogenic arterial lesions after partial nephrectomy: success rates are high, complications are infrequent, and renal function is maintained. Recommendations by interventional radiology societies are needed to standardize this treatment.
... Renal artery aneurysms (RAAs) are rare, accounting for 1% of all aneurysms and 15%-22% of visceral aneurysms (2). The incidence of RAA in the general population and angiography and computed tomography (CT) research reports were 0.1% and 0.3%-2.5%, ...
Background
Development of endovascular interventional techniques gradually replaced traditional open surgery and has become the preferred treatment for renal aneurysms. This study aimed to analyze the clinical characteristics of renal artery aneurysm (RAA) and the safety and efficacy of intravascular interventional treatment.
Materials and Methods
We retrospectively analyzed the clinical characteristics and imaging data of 23 aneurysms in 18 patients with RAA. The technical success rate, complication rate, mortality rate, reintervention rate, and use of embolization materials were evaluated.
Results
In 18 patients with RAA (age, 32–72 years, average age, 52.2 ± 11.2 years), a total of 23 aneurysms were found (diameter 0.5–5.5 cm, average diameter 2.2 ± 1.4 cm). Among them, 11 cases (61.1%) were discovered accidentally, and the remaining patients were diagnosed due to the following major complaints: four cases (22.2%) presented low back pain, two (11.1%) were due to high blood pressure, and one (5.5%) had low back pain with gross hematuria. A total of 14 aneurysms in 13 patients received endovascular interventional therapy. The technical success rate of 13 patients with renal aneurysms was 100%. Three of the 18 patients were lost to follow-up, and the remaining were followed up for 4–89 months. There was no recurrence of the aneurysm or displacement of the stent or coil.
Conclusion
Endovascular treatment for RAA has a high success rate, low complication rate, and low reintervention rate. It has the advantage of less trauma and is flexible and more targeted for different types of renal aneurysms.
... Further, it is cost-effective for patients who refuse open operation and are not candidates for other endovascular techniques [48]. However, extensive experience in embolizing liquid embolic materials is required to avoid reflux misembolism [49][50][51]. Successful cases of percutaneous direct intra-aneurysmal injection of glue or thrombin have been reported, however, they are more appropriate for superficial aneurysms and pseudoaneurysms [52][53][54]. Visceral aneurysms are located deeply and are difficult and risky for percutaneous thrombin and glue injection under the influence of respiration and other factors. ...
... Complications involve renal vascular hypertension, renal thrombosis and emboli, renal infarct, and rupture. 7 Although rupture is a relatively infrequent phenomenon (5 to 10%), it is associated with high mortality rates (80%). 1 In our case, the RAA was an incidental finding during investigation of refractory SAH of renovascular etiology. ...
... This type of aneurysm is defined as challenging in the literature, particularly when adjacent to arterial bifurcations, and open surgical treatment (endoaneurysmorrhaphy, nephrectomy, or autotransplant) has been the established treatment for decades. 6,7 More recent studies recommend endovascular repair using remodeling techniques with stenting in conjunction with coils or liquid embolization agents, with the objective of salvaging the native renal vessels when the aneurysm is located in the main renal artery or involves bifurcations in cases of saccular RAA with wide necks. 1,2,7 Even so, these lesions are a challenge to treat with this type of repair because of the difficult anatomy, demanding more complex techniques. ...
... 1,2,7 Even so, these lesions are a challenge to treat with this type of repair because of the difficult anatomy, demanding more complex techniques. 1,7 Along the same lines, fusiform type II RAA are still very difficult to treat percutaneously. 1,7 Notwithstanding, the efficacy of endovascular repair has been confirmed at 89.7 to 98% of cases, with reduced morbidity, operating time, and length of postoperative hospital stay, in addition to reduced surgical trauma. ...
Resumo O aneurisma da artéria renal é uma condição rara, que vem sendo cada vez mais diagnosticada devido ao uso mais amplo da angiotomografia. Descrevemos um caso de aneurisma da artéria renal tipo II complexo em uma paciente com hipertensão arterial sistêmica e doença renal crônica não dialítica. O tratamento estabelecido foi o reparo endovascular através da combinação da técnica de remodelamento com stents em T e molas, para a preservação dos ramos arteriais renais. Foram obtidos resultados arteriográficos satisfatórios e boa evolução clínica.
... If such anatomic criteria are not fulfilled, it can result in an endoleak. Type 3 (intralobar aneurysms arising from small segmental arteries or accessory arteries) can be repaired endovascularly by coil or glue embolization (44). Endovascular therapy is associated with a lower incidence of complications and lower median length of stay compared to surgical repair (4 vs. 7 days, P < 0.001) (46). ...
Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. This article provides a comprehensive review of the role of interventional radiologists in transcatheter interventions in various pathologies involving the main renal arteries with analysis of epidemiology, pathophysiology, newer interventional techniques, and management options.
... For narrow-necked saccular aneurysms coil embolization remains the most used endovascular technique to exclude the aneurysm and maintain regular flow in the parent artery [124]. For renal fusiform aneurysms involving distal branches, embolization with coils or liquid embolic agents (or particles) can be performed with acceptable minimal parenchyma sacrifice due to poor collateral formation [125]. In the case of widenecked saccular aneurisms, fusiform aneurysms or complex aneurysms, covered stent or stent/balloon-assisted coil embolization represent important endovascular alternative options to simultaneously exclude the aneurysm and preserve the renal vascularization [21,50,126]. ...
Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.
... Liquid embolic agents such as cyanoacrylates or ethylene vinyl alcohol copolymers may be used to completely fill in the aneurysmal sac after partial coiling, avoiding the use of too many coils or when packing is not possible anymore due to lack of space. 8,9 Technical success of the embolization technique in the treatment of RAAs across larger series is reported as 73% to 100%. Rates of morbidity are highly variable (13%-60%) and include mainly thromboembolism leading to end-organ malperfusion and subsequent postembolectomy syndrome. ...
Visceral Aneurysms: New Tools on the Block.
SPLENIC ANEURYSM TECHNIQUES WHILE PRESERVING THE SPLEEN.
The classic treatment for splenic aneurysms is splenectomy. Unlike the liver, kidney, or mesenteric artery, the spleen is not essential and could be removed without compromising a patient’s life. However, the spleen has important immunologic and hematologic functions, so
preserving the spleen is highly recommended. Although the splenic artery is the only vessel that provides direct flow to the spleen, the spleen can be supplied by collateral arteries, making it quite resistant to ischemia when there is a splenic artery occlusion.
Because of the tortuosity, the loops, and sometimes a steep angulation of the celiac trunk, the access through the splenic artery into the aneurysm sac is often a challenge. Due to the difficulty to navigate into the aneurysm sac, a coaxial technique using soft microcatheters and microwires is often required. The sandwich technique, which occludes the splenic artery using coils or plugs just
distal and proximal to the aneurysm neck, is an effective and safe endovascular technique to treat a splenic aneurysm. Nevertheless, the current trend is to exclude the splenic aneurysm while maintaining patency and direct flow to the spleen. Each splenic aneurysm should be evaluated individually, and currently, there is no standard technique for the treatment of this disease Aneurysm coiling, like brain aneurysm treatment, is the most popular approach. A self-expanding flexible stent graft without coils could be used in the few cases where the aneurysm is located proximally in a straight portion of the splenic
artery, without divergence between the proximal and distal caliber.
... Some authors reported success of treatments using coils embolization for larger pseudoaneurysms lesion measuring 10 cm. 3 Factors that may preclude endovascular management are size and multiplicity, although there have been reports of successful endovascular management for giant (10 cm) RAP endovascularly. ...
Renal artery pseudoaneurysm (RAP) is an uncommon vascular lesion. Early detection and treatment of renal artery pseudoaneurysm is important because it can rupture and lead to life-threatening hemorrhage. Recent advances in endovascular interventions can prevent potentially challenging open surgery. We describe a case 66 year old patient who presented with a painful abdominal lumbar mass. CT scan show a giant renal artery pseudoaneurysm. We discuss management of giant renal artery pseudoaneurysm, both open surgery and endovascular surgery. Endovascular arterial embolization and stent techniques is feasible. However, open surgical treatment remains to be most effective and radical method in emergency setting.
... Liquid injection into the sac with balloon remodeling technique may even be used in selected aneurysms in well-trained hands. [49][50][51]. ...
The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.
... (9) Se cree que las lesiones responsables de la hematuria ocurren después o durante la dilatación del tracto y casi siempre son ubicados en arterias segmentarias. (9,10) La arteria lacerada es un sistema de alta presión que se filtra en el sistema de baja presión de una vena que conduce a la formación de FAV o al tejido areolar hiliar que conduce a la formación de pseudoaneurismas. (11) La embolización renal selectiva se considera actualmente la técnica de elección para el tratamiento de las complicaciones vasculares secundarias a los procedimientos renales percutáneos, con una tasa de éxito >80% y una baja tasa de complicaciones. ...
... (11) La embolización renal selectiva se considera actualmente la técnica de elección para el tratamiento de las complicaciones vasculares secundarias a los procedimientos renales percutáneos, con una tasa de éxito >80% y una baja tasa de complicaciones. (10) Los microcatéteres se utilizan para permitir un enfoque superselectivo de las ramas segmentarias distales, minimizando la pérdida de parénquima renal viable. (12) Las complicaciones que pueden desarrollarse durante la embolización son limitadas e incluyen complicaciones relacionadas con la punción arterial femoral, cateterismo selectivo de un vaso y complicaciones relacionadas por el mismo procedimiento, como la embolización no dirigida y el síndrome posterior a embolización (dolor lumbar, fiebre, leucocitosis). ...
Descripción del caso clínico:
Masculino de 48 años con antecedente de enfermedad de las plaquetas gigantes y diagnóstico de riñón en herradura con litiasis renal, se realizó nefrolitotomía percutánea estándar 24Fr, se presentó 10 días posteriores al evento quirúrgico con hematuria macroscópica anemizante, formadora de coágulos, por lo que se sospecha de fístula arteriovenosa, se solicita valoración al servicio de cardiología intervencionista confirmando el diagnóstico y realizando embolización superselectiva en arteria segmentaria anterior y posterior, con resolución completa de la hematuria.
Relevancia:
Presentar una complicación poco frecuente de la nefrolitotomía percutánea como es la hematuria secundaria a fístula arteriovenosa en paciente con anomalía de la fusión renal resuelta mediante mínima invasión.
Implicaciones clínicas:
Tomar medidas en este grupo de pacientes para reducir esta complicación que puede poner en peligro la vida y el manejo mediante embolización superselectiva para evitar un deterioro de la función renal.
Conclusiones:
El acceso percutáneo guiado con ultrasonido y Doppler color puede permitir evitar la vasculatura renal durante la punción y el uso de tractos miniaturizados podría reducir el desarrollo de lesión a arterias segmentarias con posterior desarrollo de fistulas. La embolización es segura y efectiva en este grupo de pacientes.
