47 - Young Investigator Meeting
Young Investigator Meeting
4. November 2022, 13:00 - 14:00, Gartensaal 2
Open surgical repair of a large renal artery aneurysm: Technical Note
C. Schürmann, H. L. Chan, M. Menth, E. M. Psathas, Presenter: C. Schürmann (Fribourg)
A 54-years old male patient known for treated arterial hypertension was referred to our department due to the incidental finding of a 35mm asymptomatic aneurysm of the distal left renal artery (Figure 1). Due to the localization and the multiple distal renal branches arising from the aneurysm sac, endovascular repair was deemed unsuitable and open repair was planned.
Under general anesthesia, a median laparotomy and right median visceral rotation was performed anteriorly to the Gerota fascia. After mobilization of the left renal vein caudally, the proximal and distal branches of the left renal artery were controlled using vessel loops (Figure 2). After systemic anticoagulation, the proximal and distal branches of the renal artery were clamped and a longitudinal incision was performed at the cephalad part of the aneurysm sac. The orifices of the outflow branches were identified and the most cephalad part of the aneurismal sac was excised (Figure 3). Direct suture of the remaining sac was performed, with a total clamping time of 12 minutes (Figure 4). After de-clamping, a normal Doppler waveform was obtained on each individual outflow renal branch. Further banding of the remaining sac was performed using an 8mm PTFE graft.
Postoperatively, the patient maintained adequate urine output and normal renal function and returned home on postoperative day 10. Postoperative CTA revealed reduction of the aneurysm sac, and patency of all major outflow arteries (Figure 5).
When multiple distal branches arise from the aneurysm sac, open repair remains the best option in fit patients. Operative techniques vary from ex-vivo reconstruction, venous bypass, resection with direct anastomosis, patch angioplasty to aneurysmorraphy with banding. Surgeons should be prepared to adapt their strategy based on the anatomy and perioperative local findings. Aneurysmorraphy allows for minimal renal ischemia and preservation of multiple outflow vessels, however long term follow-up is recommended to exclude further aneurismal degeneration of the remaining aneurysmal sac.