Open reconstructive surgery for renal artery aneurysm

THE OBJECTIVE was to evaluate the immediate results of open reconstructive operations for renal artery aneurysm.

METHODS AND MATERIALS . From March 2019 to September 2023, 55 patients with visceral artery aneurysms were operated at the Department of Vascular Surgery at the Pavlov University. 4 patients with renal artery aneurysms were operated on by open surgical method and 5 patients underwent endovascular operation. There are two clinical cases of open reconstruction of renal artery aneurysm in situ and one ex vivo. In all cases, the indication for the operation was the presence of a symptomatic aneurysm. For in situ reconstructions, a retroperitoneal thoracophrenopararectal access to the tenth intercostal space on the left side with the opening of the left pleural cavity and partial diaphragmatic cavity and a transverse laparotomy of «chevron» type were used. Autovena was used as a bypass. For surgery of the renal artery ex vivo laparoscopic nephrectomy with autotransplantation of the kidney was performed. In the near postoperative period, we made the assessment of the patency of the reconstruction zone using MSCT angiography, the analysis of indicators of renal function.

RESULTS . All the observations noted satisfactory near-term results – the reconstruction zone is unobstructed, indicators of renal function without negative dynamics, absence of clinical manifestations of this pathology. Long-term results   (observed for more than 4 years) were traced in one patient. During this period, normal renal function and adequate functioning of the reconstruction zone are maintained.

CONCLUSION . Open reconstructive surgery in the surgical treatment of renal artery aneurysm remains relevant due to the inability in some cases to perform its endovascular correction without high risk of ischemic damage to the parenchyma of the kidney.

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