Large Renal Artery Aneurysm Treated With Stent Graft
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 35×33×31 mm, located just at the midportion of the right renal artery (Figure 1).
Because of the resistant hypertension and the risk of rupture of the aneurysm, the patient was treated with a 5.0×26-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).
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).