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(Circulation. 2006;113:e848-e849.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Large Renal Artery Aneurysm Treated With Stent Graft

Muzaffer Degertekin, MD, PhD, FESC; Fatih Bayrak, MD; Bulent Mutlu, MD; Bengi Gürses, MD; Salih Güran, MD; Ertan Demirtas, MD

From the Departments of Cardiology (M.D., F.B., E.D.) and Radiology (B.G.), Yeditepe University Hospital; Department of Cardiology, Kosuyolu Heart and Research Hospital (B.M.); and the Department of Radiology, SONOMED (S.G.), Istanbul, Turkey.

Correspondence to Dr Muzaffer Degertekin, Yeditepe University Hospital, Department of Cardiology, Istanbul, Turkey, Devlet yolu Ankara Cad. No. 102–104, 34752 Kozyatag Istanbul. E-mail mdegertekin{at}yeditepe.edu.tr

Renal artery aneurysms are uncommon, and the underlying cause ranges from fibromuscular dysplasia to atherosclerosis. Hypertension is the most common presenting symptom. The natural history is unclear, but the likelihood of rupture appears to increase as the diameter of the renal artery aneurysm exceeds 15 mm.

A 54-year-old woman with resistant hypertension despite a combination of 3 antihypertensive drugs who was referred for workup of renovascular hypertension was incidentally noted to have an aneurysm of the right renal artery during magnetic resonance angiography (Figure 1). No renal artery stenosis was noted. Magnetic resonance angiography revealed a saccular-shaped aneurysm, measuring 35x33x31 mm, located just at the midportion of the right renal artery (Figure 1).

View larger version (43K): [in this window] [in a new window]   Figure 1. A, Contrast-enhanced, 3-dimensional renal substracted angiographic images showing a 3.5-cm saccular aneurysm located at the midportion of right renal artery. B, Note the delayed corticomedullary phase of the right kidney when compared with left kidney, which is probably due to the steal phenomenon caused by the aneurysm.

Because of the resistant hypertension and the risk of rupture of the aneurysm, the patient was treated with a 5.0x26-mm balloon-expandable Jostent GraftMaster stent (Abbott Vascular Instruments, Germany) delivered to the site of aneurysm over a 0.014-inch coronary guide wire (Figure 2). Final angiography demonstrated exclusion of the aneurysm (Figure 2).

View larger version (109K): [in this window] [in a new window]   Figure 2. A, Selective right renal angiogram demonstrates saccular aneurysm. B, Inflation of the balloon for stent delivery. C, Stent delivered at the site of aneurysm. D, Final angiography after stent delivery demonstrates exclusion of the aneurysm. E and F, Control selective renal angiography at 6 months.

At 6-month clinical follow-up, the patient’s blood pressure was under control with only 1 antihypertensive drug. Control selective renal angiography at 6 months demonstrated persistent exclusion of the aneurysm and patency of the stent graft (Figure 2).

	Acknowledgments

 
Disclosures

None.

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