Renal Artery Aneurysm Repair With Balloon-assisted Coil Embolization

Dongjin Suh; Crystal Rodriguez; Adeola T. Odugbesi

doi:10.1016/j.jvs.2023.06.110

Objective Several endovascular techniques have been described for repairing renal artery aneurysms (RAA). Balloon assisted coil embolization (BACE) is a technique well-described in field of interventional neuroradiology but less known in vascular surgery. We report our recent experience of BACE in a young asymptomatic female with a right saccular RAA (11 mm) located at the hilum. Methods Right common femoral artery was accessed under ultrasound guidance and the access sheath was upsized to a 7F Ansell sheath followed by systemic heparinization. Right renal artery was selected with a SOS Omni catheter for angiogram to delineate branch anatomy followed by advancement of the Ansell sheath into the proximal right renal artery. A 0.010” Neuro synchro wire preloaded with a 5 mm × 2 cm hyperglide compliant balloon (Medtronic, Dublin, Ireland), which was parked across the neck of the aneurysm. Next, a Progreat catheter was introduced through the Ansell sheath in a buddy fashion to select the saccular aneurysm (Fig 1). The balloon was gently inflated to nominal pressure while multiple Azur coil (Terumo, Tokyo, Japan) were deployed through the microcatheter into the aneurysm. Multiple coils were deployed to densely pack the aneurysm sac. Contrast was injected through the Progreat catheter and there was no obvious filling of the aneurysm sac. The balloon was then partially inflated while the Progreat catheter was removed with care to ensure no coils were pulled. A completion angiogram through the sheath demonstrated preservation of all branches of the renal artery with complete filling of the kidney and no filling of the aneurysm sac (Fig 2). The procedure was concluded and the access site was closed with a closure device. Results A total of nine detachable coils were deployed to achieve complete embolization of the saccular RAA. Patient was discharged with daily aspirin 81 mg the following day without any complications. At 1-month follow-up, computed tomography angiography findings were unchanged from completion angiogram, and patient remained asymptomatic. Conclusions BACE is a safe and effective technique to treat RAA in hilar region while preserving branches distal to the aneurysm. Careful patient selection and preparation for open conversion were critical. Further discussion of such technique in treatment of visceral artery aneurysms is needed.

Renal Artery Aneurysm Repair With Balloon-assisted Coil Embolization

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