In Situ Open Surgical Repair for Complex Renal Artery Aneurysm: Outcomes and Technical Considerations_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DUAN Pengchao ^1,2 , CHEN Luyu ³ ,  YUAN Ding ¹ ,  ZHAO Jichun ¹

1. Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. Ward 1 of General Surgery, West China Tianfu Hospital, Sichuan University, Chengdu 610213, P. R. China;

Corresponding author：

YUAN Ding, Email: yuanding@wchscu.cn; ZHAO Jichun, Email: zhaojc3@163.com

Keywords：

renal artery aneurysm; open surgery; arterial reconstruction; outcome

DOI：

10.7507/1007-9424.202501055

Video：

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Objective To summarize the diagnosis, surgical management, and outcomes of one case of complex unilateral renal artery aneurysm repaired by in situ open surgery. Method To retrospectively analyze the clinical data of a patient with complex renal artery aneurysm admitted to the author’s hospital department in December 2021 who underwent in situ open surgery. Results The patient was a middle-aged female with a left renal artery aneurysm detected on physical examination. The renal artery three-dimensional CT imaging showed that the aneurysm was large in size and complex in anatomical structure; the aneurysm was located at the renal hilum, demonstrating multiple outflow tracts and close proximity to renal parenchyma and the ureter. Surgical management included in situ aneurysm resection combined with renal artery branch reconstruction and great saphenous vein bypass grafting. The operation duration was 5 hours with intraoperative urine output was 250 mL, and the intraoperative blood loss was about 400 mL. Four units of erythrocyte suspension, 200 mL of autologous recycled blood, and 400 mL of plasma were transfused during the operation. The results of the 36-month postoperative follow-up showed that the reconstructed renal arterial branches and the bridging vessel had satisfactory blood flow, and renal function was unaffected. Conclusions The results of this case suggest that in complex renal artery aneurysms involving multiple branches, in situ resection of the aneurysm followed by revascularization and main renal artery bypass grafting to restore flow is safe and feasible, and the long-term prognosis is good. However, it should be emphasized that the anatomy of renal artery aneurysms should be evaluated in detail preoperatively to determine the method of in situ revascularization. The results of the study also need to be further validated by larger samples and multicenter studies.

1.	Zhang J, Harish K, Speranza G, et al. Natural history of renal artery aneurysms. J Vasc Surg, 2023, 77(4): 1199-1205. e1.
2.	Pratesi C, Esposito D, Martini R, et al. Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM). J Cardiovasc Surg (Torino), 2024, 65(1): 49-63.
3.	赵纪春. 开放手术在血管腔内治疗时代的作用和地位. 中国普外基础与临床杂志, 2023, 30(5): 515-516.
4.	金涛, 赵纪春. 24例肾动脉瘤治疗回顾性分析. 中国普外基础与临床杂志, 2019, 26(2): 162-167.
5.	张健, 景在平. 肾动脉瘤诊治现状及进展. 第二军医大学学报, 2009, 30(5): 573-576.
6.	Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg, 2019, 70(5): 1694-1699.
7.	李斯亭, 李方达, 郑月宏. 肾动脉瘤外科治疗现状与进展. 血管与腔内血管外科杂志, 2021, 7(1): 86-89.
8.	Jibiki M, Inoue Y, Kudo T, et al. Surgical procedures for renal artery aneurysms. Ann Vasc Dis, 2012, 5(2): 157-160.
9.	Henriksson C, Lukes P, Nilson AE, et al. Angiographically discovered, non-operated renal artery aneurysms. Scand J Urol Nephrol, 1984, 18(1): 59-62.
10.	Robinson WP, Bafford R, Belkin M, et al. Favorable outcomes with in situ techniques for surgical repair of complex renal artery aneurysms. J Vasc Surg, 2011, 53(3): 684-691.
11.	Mazzaccaro D, Avishay DM, Righini PC, et al. Anatomic patterns of distribution of the renal arteries’ origin from the aorta. Ann Vasc Surg, 2025, 110(Pt A): 414-422.
12.	Pfeiffer T, Reiher L, Grabitz K, et al. Reconstruction for renal artery aneurysm: operative techniques and long-term results. J Vasc Surg, 2003, 37(2): 293-300.
13.	Bilman V, Mascia D, Carta N, et al. Contemporary outcomes of in situ open surgical repair of mid-portion and distal renal artery aneurysms. Ann Vasc Surg, 2022, 78: 9-18.
14.	Coleman DM, Stanley JC. Renal artery aneurysms. J Vasc Surg, 2015, 62(3): 779-785.
15.	Machado M, Machado R, Almeida R. Renal autotransplantation for the treatment of renal artery aneurysm. Ann Vasc Surg, 2022, 79: 226-232.
16.	Ghahremani JS, Chapek MA, Singh Rana SS, et al. Endovascular embolization of aneurysmal renal arteriovenous malformation. Vasc Endovascular Surg, 2025, 59(2): 198-203.
17.	Contarini E, Takagi K, Kimenai HJAN, et al. Kidney autotransplantation for renal artery aneurysm: case series and a systematic review. Ann Vasc Surg, 2021, 77: 349. e5-349. e18.
18.	Jayet J, Davaine JM, Tresson P, et al. Direct distal renal artery aneurysm repair. Eur J Vasc Endovasc Surg, 2020, 60(2): 211-218.
19.	Klausner JQ, Lawrence PF, Harlander-Locke MP, et al. The contemporary management of renal artery aneurysms. J Vasc Surg, 2015, 61(4): 978-984.
20.	Dong S, An C, Caputo FJ, et al. Renal artery reimplantation versus bypass in elective open aneurysm repair. Ann Vasc Surg, 2024, 98: 102-107.
21.	Steuer J, Bergqvist D, Björck M. Surgical renovascular reconstruction for renal artery stenosis and aneurysm: long-term durability and survival. Eur J Vasc Endovasc Surg, 2019, 57(4): 562-568.
22.	Abreu AL, Medina LG, Chopra S, et al. Robotic renal artery aneurysm repair. Eur Urol, 2020, 78(1): 87-96.
23.	Windisch OL, Matter M, Pascual M, et al. Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg, 2022, 16(6): 1471-1481.
24.	Łajczak PM, Nowakowski P, Jóźwik K. The rise of the machines: are robots the future of renal artery aneurysm repair? A systematic review. Updates Surg, 2024, 76(6): 2141-2149.
25.	Choksi H, Singla A, Yoon P, et al. Outcomes of endovascular, open surgical and autotransplantation techniques for renal artery aneurysm repair: a systematic review and meta-analysis. ANZ J Surg, 2023, 93(10): 2303-2313.
26.	Rossi M, Krokidis M, Kashef E, et al. CIRSE standards of practice for the endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol, 2024, 47(1): 26-35.
27.	Kok HK, Asadi H, Sheehan M, et al. Systematic review and single-center experience for endovascular management of visceral and renal artery aneurysms. J Vasc Interv Radiol, 2016, 27(11): 1630-1641.
28.	Laurin T, Borghese O, Branchereau J, et al. Single centre experience in open and endovascular treatment of renal artery aneurysms. Ann Vasc Surg, 2022, 79: 17-24.

1. Zhang J, Harish K, Speranza G, et al. Natural history of renal artery aneurysms. J Vasc Surg, 2023, 77(4): 1199-1205. e1.
2. Pratesi C, Esposito D, Martini R, et al. Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM). J Cardiovasc Surg (Torino), 2024, 65(1): 49-63.
3. 赵纪春. 开放手术在血管腔内治疗时代的作用和地位. 中国普外基础与临床杂志, 2023, 30(5): 515-516.
4. 金涛, 赵纪春. 24例肾动脉瘤治疗回顾性分析. 中国普外基础与临床杂志, 2019, 26(2): 162-167.
5. 张健, 景在平. 肾动脉瘤诊治现状及进展. 第二军医大学学报, 2009, 30(5): 573-576.
6. Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg, 2019, 70(5): 1694-1699.
7. 李斯亭, 李方达, 郑月宏. 肾动脉瘤外科治疗现状与进展. 血管与腔内血管外科杂志, 2021, 7(1): 86-89.
8. Jibiki M, Inoue Y, Kudo T, et al. Surgical procedures for renal artery aneurysms. Ann Vasc Dis, 2012, 5(2): 157-160.
9. Henriksson C, Lukes P, Nilson AE, et al. Angiographically discovered, non-operated renal artery aneurysms. Scand J Urol Nephrol, 1984, 18(1): 59-62.
10. Robinson WP, Bafford R, Belkin M, et al. Favorable outcomes with in situ techniques for surgical repair of complex renal artery aneurysms. J Vasc Surg, 2011, 53(3): 684-691.
11. Mazzaccaro D, Avishay DM, Righini PC, et al. Anatomic patterns of distribution of the renal arteries’ origin from the aorta. Ann Vasc Surg, 2025, 110(Pt A): 414-422.
12. Pfeiffer T, Reiher L, Grabitz K, et al. Reconstruction for renal artery aneurysm: operative techniques and long-term results. J Vasc Surg, 2003, 37(2): 293-300.
13. Bilman V, Mascia D, Carta N, et al. Contemporary outcomes of in situ open surgical repair of mid-portion and distal renal artery aneurysms. Ann Vasc Surg, 2022, 78: 9-18.
14. Coleman DM, Stanley JC. Renal artery aneurysms. J Vasc Surg, 2015, 62(3): 779-785.
15. Machado M, Machado R, Almeida R. Renal autotransplantation for the treatment of renal artery aneurysm. Ann Vasc Surg, 2022, 79: 226-232.
16. Ghahremani JS, Chapek MA, Singh Rana SS, et al. Endovascular embolization of aneurysmal renal arteriovenous malformation. Vasc Endovascular Surg, 2025, 59(2): 198-203.
17. Contarini E, Takagi K, Kimenai HJAN, et al. Kidney autotransplantation for renal artery aneurysm: case series and a systematic review. Ann Vasc Surg, 2021, 77: 349. e5-349. e18.
18. Jayet J, Davaine JM, Tresson P, et al. Direct distal renal artery aneurysm repair. Eur J Vasc Endovasc Surg, 2020, 60(2): 211-218.
19. Klausner JQ, Lawrence PF, Harlander-Locke MP, et al. The contemporary management of renal artery aneurysms. J Vasc Surg, 2015, 61(4): 978-984.
20. Dong S, An C, Caputo FJ, et al. Renal artery reimplantation versus bypass in elective open aneurysm repair. Ann Vasc Surg, 2024, 98: 102-107.
21. Steuer J, Bergqvist D, Björck M. Surgical renovascular reconstruction for renal artery stenosis and aneurysm: long-term durability and survival. Eur J Vasc Endovasc Surg, 2019, 57(4): 562-568.
22. Abreu AL, Medina LG, Chopra S, et al. Robotic renal artery aneurysm repair. Eur Urol, 2020, 78(1): 87-96.
23. Windisch OL, Matter M, Pascual M, et al. Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg, 2022, 16(6): 1471-1481.
24. Łajczak PM, Nowakowski P, Jóźwik K. The rise of the machines: are robots the future of renal artery aneurysm repair? A systematic review. Updates Surg, 2024, 76(6): 2141-2149.
25. Choksi H, Singla A, Yoon P, et al. Outcomes of endovascular, open surgical and autotransplantation techniques for renal artery aneurysm repair: a systematic review and meta-analysis. ANZ J Surg, 2023, 93(10): 2303-2313.
26. Rossi M, Krokidis M, Kashef E, et al. CIRSE standards of practice for the endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol, 2024, 47(1): 26-35.
27. Kok HK, Asadi H, Sheehan M, et al. Systematic review and single-center experience for endovascular management of visceral and renal artery aneurysms. J Vasc Interv Radiol, 2016, 27(11): 1630-1641.
28. Laurin T, Borghese O, Branchereau J, et al. Single centre experience in open and endovascular treatment of renal artery aneurysms. Ann Vasc Surg, 2022, 79: 17-24.

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