Remodeling technique using T-stenting and coils to treat complex renal aneurysm

Renal artery aneurysm is a rare condition that is being diagnosed with increasing frequency because of wider use of angiotomography. We describe a case of complex type II renal artery aneurysm in a patient with systemic arterial hypertension and non-dialysis chronic kidney disease. The treatment performed was endovascular repair using the remodeling technique with T-stenting and coils to preserve the renal arterial branches, obtaining satisfactory arteriographic results and good clinical outcomes.

Keywords:
aneurysm; renal artery; endovascular procedures

Authorship

Patrick Bastos Metzger

Escola Bahiana de Medicina e Saúde Pública – EBMSP, Salvador, BA, Brasil.Escola Bahiana de Medicina e Saúde PúblicaBrasilSalvador, BA, BrasilEscola Bahiana de Medicina e Saúde Pública – EBMSP, Salvador, BA, Brasil.

http://orcid.org/0000-0002-1717-1370

Kamilla Rosales Costa

http://orcid.org/0000-0003-1920-5666

Simone Lessa Metzger

Obra Sociais Irmã Dulce – OSID, Hospital Santo Antônio, Salvador, BA, Brasil.Obra Sociais Irmã DulceBrasilSalvador, BA, BrasilObra Sociais Irmã Dulce – OSID, Hospital Santo Antônio, Salvador, BA, Brasil.

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Correspondence Patrick Bastos Metzger Escola Bahiana de Medicina e Saúde Pública – EBMSP Rua Professor Diógenes Rebouças - Pituba CEP 41830-570 - Salvador (BA), Brasil Tel.: +55 (71) 99977-6356 E-mail: patrickvascular@gmail.com

Author information PBM - PhD in Medicina, Universidade de São Paulo (USP); Adjunct professor, Escola Bahiana de Medicina e Saúde Pública (EBMSP); Vascular and endovascular surgeon, Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV); Interventional radiologist, Colégio Brasileiro de Radiologia (CBR).KRC - 9th semester medical student, Escola Bahiana de Medicina e Saúde Pública (EBMSP).SLM - Geriatrician, Sociedade Brasileira de Geriatria e Gerontologia (SBGG); Adjunct professor, Escola Bahiana de Medicina e Saúde Pública (EBMSP); Assistant professor, Universidade Salvador (UNIFACS); Preceptor, Residência de Geriatria, Obras Sociais Irmã Dulce (OSID).

Author contributions Conception and design: PBM. Analysis and interpretation: PBM. Data collection: PBM. Writing the article: PBM, KRC, SLM. Critical revision of the article: PBM. Final approval of the article*: PBM, KRC, SLM. Statistical analysis: PBM, SLM. Overall responsibility: PBM, KRC, SLM *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

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Figures

Figures (3)

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Figure 1
(A) Angiotomography with volumetric reconstruction of the type II renal aneurysm, in anteroposterior view, showing the type II renal aneurysm involving the renal bifurcation; (B) Angiotomography with volumetric reconstruction of the type II renal aneurysm, posteroanterior view, showing the type II renal aneurysm with the branch feeding the mid pole of the kidney emerging from the type II renal aneurysm; (C) Multiplanar angiotomography slice showing in 1 – main renal artery close to the superior and inferior bifurcation; and in 2 – the artery feeding the mid pole emerging from the aneurysm; (D) Multiplanar angiotomography slice showing, at 1s – the branch feeding the upper renal pole; and AR – main renal artery; (E) Multiplanar angiotomography slice showing at 1s – the branch feeding the upper renal pole; 1i – the branch feeding the lower renal pole; and 2 – the branch feeding the mid renal pole.

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Figure 2
(A) Renal arteriography showing the complex type II renal aneurysm – before treatment; (B) Positioning the first stent at the bifurcation of the main renal artery; (C) Positioning the T stents and starting embolization via the meshes of the stent; (D) Final control arteriography showing patent feeder arteries and embolization of the renal aneurysm.

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Figure 3
(A) Angiotomographic control at 3 months showing the patent branch feeding the mid renal pole; (B) Angiotomographic control at 3 months showing the patent branches feeding the upper and lower renal poles.

Figure 1 (A) Angiotomography with volumetric reconstruction of the type II renal aneurysm, in anteroposterior view, showing the type II renal aneurysm involving the renal bifurcation; (B) Angiotomography with volumetric reconstruction of the type II renal aneurysm, posteroanterior view, showing the type II renal aneurysm with the branch feeding the mid pole of the kidney emerging from the type II renal aneurysm; (C) Multiplanar angiotomography slice showing in 1 – main renal artery close to the superior and inferior bifurcation; and in 2 – the artery feeding the mid pole emerging from the aneurysm; (D) Multiplanar angiotomography slice showing, at 1s – the branch feeding the upper renal pole; and AR – main renal artery; (E) Multiplanar angiotomography slice showing at 1s – the branch feeding the upper renal pole; 1i – the branch feeding the lower renal pole; and 2 – the branch feeding the mid renal pole.

Figure 2 (A) Renal arteriography showing the complex type II renal aneurysm – before treatment; (B) Positioning the first stent at the bifurcation of the main renal artery; (C) Positioning the T stents and starting embolization via the meshes of the stent; (D) Final control arteriography showing patent feeder arteries and embolization of the renal aneurysm.

Figure 3 (A) Angiotomographic control at 3 months showing the patent branch feeding the mid renal pole; (B) Angiotomographic control at 3 months showing the patent branches feeding the upper and lower renal poles.

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Remodeling technique using T-stenting and coils to treat complex renal aneurysm

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.