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Background Renal artery aneurysms (RAAs) are rare, with little known about their natural history and growth rate or their optimal management. The specific objectives of this study were to (1) define the clinical features of RAAs, including the precise growth rate and risk of rupture, (2) examine the current management and outcomes of RAA treatment using existing guidelines, and (3) examine the appropriateness of current criteria for repair of asymptomatic RAAs. Methods A standardized, multi-institutional approach was used to evaluate patients with RAAs at institutions from all regions of the United States. Patient demographics, aneurysm characteristics, aneurysm imaging, conservative and operative management, postoperative complications, and follow-up data were collected. Results A total of 865 RAAs in 760 patients were identified at 16 institutions. Of these, 75% were asymptomatic; symptomatic patients had difficult-to-control hypertension (10%), flank pain (6%), hematuria (4%), and abdominal pain (2%). The RAAs had a mean maximum diameter of 1.5 ± 0.1 cm. Most were unilateral (96%), on the right side (61%), saccular (87%), and calcified (56%). Elective repair was performed in 213 patients with 241 RAAs, usually for symptoms or size >2 cm; the remaining 547 patients with 624 RAAs were observed. Major operative complications occurred in 10%, including multisystem organ failure, myocardial infarction, and renal failure requiring dialysis. RAA repair for difficult-to-control hypertension cured 32% of patients and improved it in 26%. Three patients had ruptured RAA; all were transferred from other hospitals and underwent emergency repair, with no deaths. Conservatively treated patients were monitored for a mean of 49 months, with no acute complications. Aneurysm growth rate was 0.086 cm/y, with no difference between calcified and noncalcified aneurysms. Conclusions This large, contemporary, multi-institutional study demonstrated that asymptomatic RAAs rarely rupture (even when >2 cm), growth rate is 0.086 ± 0.08 cm/y, and calcification does not protect against enlargement. RAA open repair is associated with significant minor morbidity, but rarely a major morbidity or mortality. Aneurysm repair cured or improved hypertension in >50% of patients whose RAA was identified during the workup for difficult-to-control hypertension.

Introduction Renal transplantation has been performed with increasing frequency, and interventions to preserve graft function and integrity have been steadily increasing. This study examines the outcomes of endovascular therapy based on indication for renal transplant allograft salvage. Methods A prospective transplant registry was queried for all patients undergoing endovascular interventions for transplant allograft salvage from 2002 to 2011. Demographics, perioperative data, and transplant function outcomes were extracted and analyzed. Results Among 34 renal transplant recipients (62% men) who underwent endovascular interventions for graft salvage, the mean age was 48.2 years (range, 18-74 years). The indications for intervention included worsening renal function in 15, renovascular hypertension in 11, and structural abnormalities identified on noninvasive imaging in eight. Transluminal angioplasty with and without stenting was done in 26 patients: 14 patients (41.2%) with significant transplant stenosis, 11 (32.4%) with peripheral arterial disease in proximal iliac vessels, and one patient with iliac dissection. Five arteriovenous fistulas and two pseudoaneurysms required embolization. One patient required lysis for deep venous thrombosis causing obstruction of allograft outflow. There were no periprocedural deaths, and 30-day morbidity was 17.6%. Renal function improved or stabilized in 67% of patients with worsening renal function. Better blood pressure control was achieved in patients with renovascular hypertension. Mean follow-up was 4.2 years. There were no significant differences in transplant allograft survival during the duration of follow-up based on primary indication for endovascular intervention, but transplant graft survival at follow-up was significantly better in patients with renovascular hypertension at the initial endovascular intervention. Conclusions Endovascular salvage of renal allograft transplants can be safely done for various indications. The maximum benefit in renal function as assessed by serum creatinine and control of blood pressure is seen in patients with worsening renal function and in the presence of renovascular hypertension, respectively. Long-term transplant graft function was significantly better in patients with renovascular hypertension at the initial endovascular intervention.

Endovascular Interventions With Carbon Dioxide (CO2) in Renal Transplant Patients With Peripheral Arterial Disease (PAD) Is Safer and Offers Equivalent Patency Over Interventions With Standard Contrast Agents and Traditional Open Surgery Shipra Arya, Stephanie Kingman, Danielle N. Campbell, Dawn M. Coleman, Peter K. Henke, Narasimhan Dasika, Jonathan L. Eliason, John E. Rectenwald, Katherine A. Gallagher. University of Michigan, Ann Arbor, Mich