腎動脈瘤經腹腔鏡腎切除及體外修復後自體移植: 二例病例長期追蹤報告
劉惠瑛、王弘仁、莊燿吉、羅浩倫、陳彥達
高雄長庚紀念醫院 泌尿科
Renal Artery Aneurysm Managed With Laparoscopic Nephrectomy, Ex Vivo Repair, and Autotransplantation: Long-term Follow-up of 2 Case Reports
Hui-Ying Liu、Hong-Ren Wang、Yao-Chi Chuang、Hao-Lun Luo、Yen-Ta Chen
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

 

Introduction: Renal artery aneurysms (RAAs) are defined as a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery. The prevalence of renal artery aneurysms is vary between 0.01% and 1.0%, and recently increased because the widespread use of image studies [1, 2]. Indications for treatment include pain, hematuria, intrarenal thromboemboli, renovascular hypertension, a lesion diameter of >2.5 cm, interval enlargement, or lesions in women of childbearing age [2]. The most serious complication of renal artery aneurysms is rupture, which is a true critical emergency that may result in a fatal outcome [1, 3]. Although most RAAs can be treated with in vivo repair or endovascular techniques, these may not be possible in patients with complex RAAs beyond the renal artery bifurcation. We reported long-term follow-up of two cases with RAAs after surgical management. The renal function was stable, and the blood pressure was well controlled. Nephrectomy with ex vivo repair of a complicated RAA and autotransplantation is feasible and safe. 

Case 1: A 54-year-old man with history of hypertension with RAA found on computed tomography (CT). Preoperative workup demonstrated a 2cm lobulated saccular aneurysm in the distal left renal artery, which was not amendable to receive in vivo or endovascular repair. The patient underwent a left nephrectomy, ex vivo renal artery aneurysm repair, and autotransplantation. He did well postoperatively. During 5 years of long-term follow-up, stable renal function and well blood pressure control were sustained. 

Case 2: A 30-year-old man with history of atrophic right kidney and left RAA found on routine evaluation. Preoperative workup demonstrated a 2.9cm aneurysm in the left renal artery that was not amendable to either in vivo or endovascular repair. The patient underwent a left nephrectomy, ex vivo renal artery aneurysm repair, and autotransplantation. During 4 years of follow-up, stable renal function was noted.