Chapter 128 - renovascular disease aneurysm and arteriovenous fistulae

Question 1

Epidemiology of renal artery aneurysm

Answer 1

Autopsy incidence 0.01-0.09%
Angiogram incidence 0.73-0.97%
CTA incidence 0.7%

Question 2

Renal artery aneurysms are bilateral in this percentage of patients

Answer 2

10%

Question 3

Percentage of true aneurysm that are extraparenchymal

Answer 3

90%

Question 4

Peak incidence in age of patients for renal artery aneurysm

Answer 4

40-60 years

Question 5

Causes of true renal artery aneurysms

Answer 5

1) congenital medial degenerative process
2) atherosclerosis
3) FMD

Question 6

Percentage of renal artery aneurysms that are saccular

Answer 6

75%

Question 7

Most common place of renal saccular aneurysm and fusiform aneurysm

Answer 7

saccular - main renal artery bifurcation

fusiform - main trunk

Question 8

Medial fibroplasia characteristic

Answer 8

1) multiple stenosis and poststenotic dilatation in distal 2/3 of renal artery

Question 9

Rate of renal artery aneurysm in FMD patients

Answer 9

9.2%

Question 10

Rare congenital cause of renal artery aneurysm

Answer 10

Ehlers-Danlos

Question 11

Incidence of dissection in FMD

Answer 11

0.5-9%

Question 12

Causes of intrarenal aneurysms

Answer 12

1) congenital
2) collagen vascular disease
3) posttraumatic
4) associated with AVF

Question 13

Symptoms of renal artery aneurysm

Answer 13

1) rupture = pain, distension, hypotension
2) HTN due to distal embolization and segmental hypoperfusion
3) hematuria

Question 14

Mortality rate after renal artery aneurysm rupture

Answer 14

10% in non-pregnant women and men

Question 15

Size cutoff for repairing renal artery aneurysm

Answer 15

Traditionally 2cm but is being challenged
some say 3 some say 4

women of child bearing age, repair when 1.5x adjacent size

Question 16

Pregnancy causes increased risk of rupture because

Answer 16

1) hyperdynamic state: increased blood volume and cardiac output
2) hormonal influences
3) increased intraabdominal pressure due to gravid uterus

Question 17

Mortality rate of pregnant renal artery aneurysm rupture

Answer 17

Maternal 55%

Fetal 85%

Question 18

Prevalence of HTN in patients with renal artery aneurysm

Answer 18

80%

Question 19

Kocher maneuver

Answer 19

Reflect right colon and duodenum medially

Question 20

Renal Aneurysm repair options

Answer 20

1) aneurysmorrhaphy
2) patch repair
3) reimplantation
4) bypass
5) extracorporial repair
6) nephrectomy (rupture)
7) endo embolization
8) endo stent

Question 21

Mortality for renal artery aneurysm repair

Answer 21

1.7%

Question 22

Patency after renal artery aneurysm repair

Answer 22

96% in 4 years

Question 23

Mortality after ex vivo renal artery aneurysm repair

Answer 23

0-9.6%

Question 24

Morbidity after renal artery aneurysm repair

Answer 24

10% open and endo

Question 25

FMD aneurysm treatment

Answer 25

Balloon into the stenotic area

Surgery open

Question 26

Intrarenal aneurysm treatment

Answer 26

Partial nephrectomy

Embolization

Question 27

Intrarenal aneurysm often associated with this disorder

Answer 27

polyarteritis nodosa

Question 28

Incidence of true congenital AVM of kidneys

Answer 28

0.04%

1 in 30,000 autopsies

Question 29

Congenital AVM in kidney key points

Answer 29

1) 1/4 of all renal AVF
2) right kidney more often
3) cirsoid or varix-like
4) not neoplastic
5) irregular fibrosis or intimal hyperplasia and medial hypertrophy

Question 30

Renal AVF key points

Answer 30

1) traumatic accounts for 70%
2) 1-2% from needle biopsy
3) 15-18% from arteriography
4) associated with FMD when dysplastic/aneurysmal artery erodes into neighbor veins
5) associated with renal cell carcinoma

Question 31

Clinical presentation of renal AVF

Answer 31

1) hematuria 72% of congenital cases
2) HTN due to arterial steal and relative ischemia
3) CHF due to high output heart failure (tachy, LV hypertrophy, cardiomegaly, palpable thrill in flank)
4) continuous abdominal bruit

Question 32

Endovascular treatment of renal AVF key points

Answer 32

1) coils and balloons used for larger vessel; liquid agents for smaller
2) loss of functional renal parenchyma 0-30%
3) recurrence 50% when Gelfoam used (reabsorbed)
4) covered stents or stent assisted coiling
5) RFA

Question 33

Post-embolization symptoms

Answer 33

1) transient fever
2) leukocytosis
3) hypertension

Question 34

Endovascular treatment of renal AVF success rate

Answer 34

80%