To report a wide-necked renal artery aneurysm treated successfully with stent-assisted Gugliemi detachable coil occlusion, assisted by three-dimensional (3-D) angiography.
A 56-year-old woman with history of hypertension presented with a 2.5-cm wide-necked saccular aneurysm involving her distal right renal artery. A balloon-expandable stent was positioned across the neck of the aneurysm and multiple Gugliemi detachable coils were deployed through a microcatheter inserted through the interstices of the stent into the aneurysm sac, guided by 3-D angiography. Follow-up 3-D angiography at 6 months revealed a patent renal artery with continued exclusion of the aneurysm and preservation of renal blood flow.
Stent-assisted coil occlusion assisted by 3-D angiography is a potential renal-sparing endovascular approach to treating wide-necked renal artery aneurysms with complex vascular anatomy.
"During these procedures, a suitable device is released within the feeding vessel across the neck of the aneurysm to prevent coil prolapse during deployment and facilitate denser packing of the aneurysm, with the aim of reducing the likelihood of parent-vessel embolization. Stents employed are either self-expandable (bifurcation and segmental artery) or balloon-expandable (main stem) depending on the reference vessels and operator preference [7,11]. "
[Show abstract][Hide abstract] ABSTRACT: Background
Renal artery aneurysm is a rare disorder with a high mortality rate in the event of rupture, the most frequent complication, which can also occur in lesions smaller than those indicated for treatment by current criteria. Surgery is still the first-line treatment, although a growing trend toward endovascular management of visceral artery aneurysms has emerged because of the high efficacy and low invasiveness that has been demonstrated by several authors. Treatment of wide-necked aneurysms and, depending on location, those at renal artery bifurcations or distal branches is more complex and may require invasive surgical techniques, such as bench surgery.
We describe the successful use of a new neurointerventional coil to treat an enlarging wide-necked segmental-branch renal aneurysm in an elderly woman who was not a candidate for surgery because of several comorbidities.
The technique described allowed safe, successful treatment of a wide-necked aneurysm in an unfavorable vascular territory, reducing the risk of downstream artery embolization and consequent parenchymal damage and decreased renal function. In similar cases, other endovascular devices have often proven to be ineffective at nephron sparing. To validate the safety and efficacy of this system, more cases treated in this manner should be studied.
"The aneurysm is generally occluded by inserting metallic coils into the sac. If the neck is wide, then a fenestrated endoprosthesis can be initially used to cover the aneurysm, after which the coils can be inserted via the windows in the prosthesis (32). The use of a recently developed small covered endoprostheses can sometimes simplify the procedure. "
[Show abstract][Hide abstract] ABSTRACT: Therapeutic embolization is defined as the voluntary occlusion of one or several vessels, and this is achieved by inserting material into the lumen to obtain transient or permanent thrombosis in the downstream vascular bed. There are a number of indications for this approach in urological practice, in particular for the patients with parenchymatous or vascular kidney disease. In this review, we present the different embolization techniques and the principally employed occluding agents, and then we present the principal clinical indications and we discuss other pathologies that may benefit from this non-invasive therapy. The complications, side effects and main precautions associated with this approach are also described.
Korean journal of radiology: official journal of the Korean Radiological Society 04/2010; 11(3):257-68. DOI:10.3348/kjr.2010.11.3.257 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe a new type of stent consisting of a 3-dimensional (3D) braided tube made of 2 interconnected layers without any covering to treat a renal artery aneurysm.
A 78-year-old hypertensive man with multiple comorbidities was incidentally found to have a large (28- x 30 mm) saccular aneurysm in the main right renal artery involving the inferior renal artery. Via a percutaneous femoral approach, a 6- x 30-mm Multilayer stent was deployed easily in front of the aneurysm neck covering the inferior renal artery. Blood flow inside the sac was immediately and significantly reduced. All the renal artery branches remained patent. Blood pressure returned to normal after the procedure. At 6 months, angiography showed complete shrinkage of the aneurysm wall; all the inferior renal artery branches remained patent.
The 3D multilayer fluid modulating stent concept appears to be a viable alternative for renal aneurysm exclusion. A larger study is underway to evaluate this new stent in other peripheral aneurysms.
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