Renal artery aneurysms (RAAs) are localized dilatations of the renal artery or its branches, exceeding twice the diameter of the native artery. They are uncommon and their treatment is often a challenge for the vascular surgeon.
Open surgery for RAAs is still a standardized and resolutive solution, although it can often be complex and rather invasive. Endovascular repair (ER) is a valid option nowadays in selected cases, especially if the aneurysm does not involve the main artery bifurcations or collateral vessels.
Nephrectomy should be considered only when every previous rescue attempt of the kidney has failed, in case of massive renal ischemia secondary to acute thrombosis and in all cases unsuitable for any treatment and at high risk of rupture.
Hilar renal artery aneurysms (HRAAs) represent a subgroup of RAAs, located very close to the renal parenchyma and usually involving terminal branches. Because of their very distal location, they are hardly ever suitable for an ER, while open repair could be extremely demanding. In this regard the ex vivo repair, associated with low-invasive solutions for kidney explantation/autotransplantation, is still a potentially valid alternative to the nephrectomy.
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