Endovascular treatment of segmental renal artery aneurysm using neurovascular technique

BACKGROUND Coil embolization of visceral artery aneurysms is a well-established technique that typically results in complete occlusion of the originating vessel. We adapted a technique that is used for the treatment of cerebral aneurysms to embolize a symptomatic renal artery aneurysm and preserve flow through all the segmental arteries.
METHODS The patient was a 49 year old woman who presented with persistent right upper quadrant pain. An exhaustive evaluation was completely negative with the exception of a 1.5 cm saccular aneurysm arising from the right lower segmental renal artery. Endovascular treatment was recommended. Utilizing a right femoral access, we placed a 6 Fr RDC guide cath in the main renal artery. Through a twin-port Tuohy-Borst adapter, we selectively catheterized the aneurysm arising from the lower segmental branch of the right renal artery with a Prowler Plus 021 microcatheter. A Hyperglide neuro compliant balloon catheter was placed across the ostium of the aneurysm to prevent dislodgment of embolic coils and preserve the shape of the residual vessel lumen. A series of progressively smaller detachable coils (Ultrasoft GDC) was placed within the aneurysm to achieve complete thrombosis. Angiography showed successful exclusion of the aneurysm and preservation of flow in all segmental renal artery branches.
RESULTS No complications were observed in the perioperative or postoperative period. At one year follow up, she is asymptomatic and the aneurysm remains occluded.
CONCLUSIONS This two-catheter neurovascular technique offers an innovative, safe, controlled endovascular approach to the treatment of renal artery aneurysms that preserves flow in the originating vessel.