2025年 · 第105卷第34期

A 52-year-old female was admitted to the Department of Vascular Surgery, Second Xiangya Hospital, Central South University on August 5, 2021 due to "physical examination found left renal aneurysm for 3 weeks". Deny symptoms such as low back pain and hematuria. He had a history of hypertension for 5 years. He underwent laparoscopic total hysterectomy for "cervical cancer" 7 years ago. He denied his history of trauma and special medication. Admission physical examination: blood pressure 140/80 mmHg (1 mmHg =0.133 kPa), body temperature 36.0 ℃, pulse 80 beats/min, clear mind, soft abdomen, no tenderness and rebound pain, no palpable mass in the kidney area, no percussion pain. Laboratory tests at admission: creatinine 54.7 μ mol/L, urea 4.58 mmol/L, rheumatology immunology and vasculitis tests were negative. Total aortic CT angiography (CTA) showed that there was a true aneurysm with a diameter of about 3 cm at 1 cm near the renal hilum of the left renal artery (Figure 1, indicated by arrows). According to the medical history, physical examination and imaging examination, a true renal artery aneurysm was diagnosed. Digital subtraction angiography (DSA) of the left renal artery was performed under local anesthesia. Intraoperatively, it was confirmed that there was a true aneurysm of the left renal artery of 30 mm ×24 mm near the renal hilum, and three branch arteries were communicated with the aneurysm (Figure 2, shown by arrows). Trans-brachial vascular approach, 1 Gore was first inserted^®Viabahn^®A covered stent (6.0 mm ×2.5 cm) spans the base of the aneurysm and extends to the distal branch; Subsequently, several free coils (8 mm ×6, 5 mm ×3) were used to embolize the aneurysm cavity. Postoperative angiography showed complete isolation of the aneurysm and good preservation of renal perfusion (Figure 3, shown by arrows). Renal function was normal after postoperative review, and aspirin antiplatelet treatment was given for 3 months after discharge. Follow-up on 6 Nov 2023 showed that the patient was generally in good condition, the stent was patent (Figure 4, indicated by arrows), and the renal function remained normal. In severe cases, renal aneurysm can cause hypertension, low back pain, hematuria and even rupture. Indications for surgery included diameter ≥2.0 cm, pregnant and/or pregnant women, co-clinical symptoms, high-risk morphology, or rupture. In this case, endovascular repair with covered stent combined with coil embolization has the advantages of less trauma, quick recovery and short hospital stay, which is a safe and effective choice for the treatment of renal aneurysm.