Background:Renal artery aneurysms(RAA) are uncommon vascular entities; however, the detection rate has increased due to the increased use of angiography and computed tomography. Because it is less invasive, endovascular treatment of RAAs has gained acceptance as an alternative to surgery over the past several years. However, there is limited data regarding the results of coil embolization for RAAs. We report our case series of 8 patients treated using endovascular embolization with Guglielmi Detachable Coils(GDC) and temporary balloon occlusion of the aneurysm neck.

Methods:Over an 8-year period, endovascular embolization using GDCs and temporary balloon occlusion were performed on 8 patients with RAAs. There were 5 females and 3 males, ranging in age from 23 to 65. Three patients were found to have RAAs associated with fibrous dysplasia(FD) and HTN. One patient was found to have a RAA on workup for hematuria and two patients had aneurysms that were found incidentally. RAA sizes ranged from 7mm to 27mm located at primary to secondary bifurcations. An angiogram is performed to define the aneurysm. Cirrus 3.5 mm balloon catheter(Medtronics) is advanced to the parent artery of the aneurysm. Tracker-18 microcatheter with a double marker(Target Therapeutics) is advanced into the aneurysm. GDCs, composed of a Teflon-coated delivery wire attached to a pliable platinum coil, is placed into the lumen of the aneurysm until the aneurysm is densely packed with coils. Before detachment, the balloon is temporarily inflated to prevent unintentional coil migration. A final angiogram is performed to confirm obliteration of the aneurysm and patency of the parent artery.

Results:All 8 patients underwent successful occlusion of RAAs using GDC embolization and temporary balloon occlusion. Success was defined as a radiographically obliterated aneurysm on angiography. 3 patients had small and clinically asymptomatic renal infarctions. All serum creatinines remained unchanged postoperatively and in follow-up. 1 patient had a small protrusion of coil into parent artery. The 3 patients with HTN associated with FMD had improvement of their HTN (mean SBP drop of 40), with one patient now weaned off of one of his antihypertensive medications. Patients had follow up from 1 to 36 months(median of 6 months) using imaging studies including ultrasound,x-ray,CTA,MRA revealing no coil migration and no residual aneurysms.

Conclusions:In summary, endovascular embolization of RAAs is successful using GDCs and temporary balloon occlusion. This minimally invasive procedure offers a safe alternative to surgical repair. Although selective renal infarction may occur, these have not been clinically significant.

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