Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas

Objective: To describe our experience with the treatment of renal artery aneurysms (RAAs) and renal arteriovenous fistulas (RAVFs) by transcatheter techniques with special consideration given to indications, technical options, and complications. Methods: Over the last 7 years (2004-2011), endovascular treatment of nine RAAs and six RAVFs in 15 patients (11 women; mean [standard deviation] age, 42 [15] years; range, 18-75 years) was retrospectively reviewed. Seven aneurysms and six arteriovenous fistulas were treated with coil embolization. One aneurysm was treated with the stent graft, and the other aneurysm was treated with coil embolization combined with stent graft. Electronic medical charts were reviewed, and demographic, clinical, procedural, and follow-up data were analyzed. Results: The lesion was asymptomatic in seven patients and symptomatic in eight patients, including ruptures in two patients. The most common comorbidity and associated risk factor was hypertension (n = 8). The technical success rate was 100%. There was no periprocedural mortality or major complications. The only complication was postembolization syndrome in nine patients. Mean clinical follow-up was 24.7 months, and mean imaging follow-up was 16.3 months. During the imaging follow-up, partial renal infarcts were detected in six patients, with no evidence of renal insufficiency. No recurrence was observed. Conclusions: At our institution, endovascular therapy represents the first-line treatment of RAAs and RAVFs. Postembolization syndrome and segmental renal infarcts are common events but were not found to be clinically significant. (J Vasc Surg 2013;57:765-70.)