Laparoscopic Repair Of Renal Artery Aneurysm

Renal artery aneurysms may cause renal function deterioration and renovascular hypertension. Furthermore, large aneurysms (> 2 cm) have the increased risk of rupture. When indications for intervention are present, the conventional open surgical renal revascularization is the gold-standard treatment, which is known to be associated with significant postoperative morbidity.

Gill et al. from the Cleveland Clinic reported their initial experience with repair of renal artery aneurysm performed laparoscopically to minimize the patient morbidity associated with renal revascualrization (15). This report represented the initial laparo-scopic renovascular surgery in the clinical setting.

The initial clinical laparoscopic renovascular surgery was performed in a 57-year-old woman with 3-cm saccular aneurysm of the distal left main renal artery that was confirmed by selective left renal arteriography. A transperitoneal four-port approach was used. Meticulous dissection led to the identification of the renal artery aneurysm, which was mostly covered by the main renal vein. Following proximal and distal control of the renal artery with respect to the aneurysm using laparoscopic bulldog clamps, the aneurysm was bivalved, and the excess aneurysm sac was meticulously excised. The edges of the excision site were then trimmed and reconstructed using intracorporeal laparoscopic suturing techniques. Following the removal of the vascular clamps, there was prompt return of pink coloration to the kidney and excellent pulsation in the distal main renal and segmental arteries, with no bleeding from the anastomotic suture line or compromise of the caliber of the reconstructed renal artery segment. Total operative time was 4.2 hours, and total blood loss was 100 mL. Total renal artery clamping time was 31 minutes. There was no perioperative complication. Hospital stay was two days. Renal scan on postoperative day 1 showed good perfusion to the left kidney without evidence of acute tubular necrosis, and there was improved relative left renal function (from 37% before the surgery to 43% after the surgery). Postoperative angiography showed normal caliber of the reconstructed artery at one month.

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