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Abstract: FR-PO544

Renal Artery Aneurysm in Dialysis Patients

Session Information

Category: Trainee Case Report

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Saeed, Maryam K., Baylor College of Medicine, Houston, TX, Sugar Land, Texas, United States
  • Raghavan, Rajeev, Baylor College of Medicine, Houston, Texas, United States
Introduction

Renal artery aneurysms(RAAs) are rare(less than 1% in the general population),with most found incidentally on abdominal imaging.Aneurysm rupture has a high mortality and morbidity if not recognized in a timely manner

Case Description

We present two case-both end stage renal disease(ESRD) patients who presented with RAA rupture.The first patient was a 56 year old African American male on intermittent hemodialysis who presented with complaints of right sided flank pain for one day,without associated trauma, fevers, hematuria and hemoglobin of 7.7mg/dl on labs.A CT scan showed a right retroperitoneal hematoma.CT angiogram revealed two small pseudoaneurysms in the right renal artery with active extravasation that was successfully coiled.The second patient,a 72 year old Hispanic male,on peritoneal dialysis, was admitted to the critical care unit after an ischemic stroke.He was found to have Atrial fibrillation and started on a heparin drip for anticoagulation.His anti hypertensive medications were held to allow for permissive anti-hypertension.However, his hemodynamics worsened shortly afterwards requiring pressor support and stat labs revealed a drop in hemoglobin to 3.6mg/dl from 9.9mg/dl.Point of care ultrasound demonstrated a hypoechoic area around the left kidney. CT angio showed multiple areas of contrast blush in the left kidney consistent with active bleeding. IR guided coil embolization of the left renal artery was performed successfully and bleed was stopped.

Discussion

RAAs are associated most commonly with hypertension,followed by connective tissue diseases like fibromuscular dysplasia,Ehler–Danlos syndrome, Marfan syndrome, and vasculitis(such as polyarteritis nodosa and chronic granulomatosis with polyangiitis).Atherosclerosis is also associated with RAA but exact causative mechanism is not known. RAA rupture may present with back pain, abdominal pain, ileus, and hemorrhagic shock with CT showing retroperitoneal hematoma.Patients with chronic kidney disease and end stage renal disease have several risk factors for development of RAAs and rupture.Clinicans should have high suspicion for RAA rupture in dialysis patients presenting with abdominal pain, uncontrolled hypertension and sudden drop in hemoglobin. Endovascular treatment is a minimally invasive option available to treat renal artery aneurysm even in setting of aneurysmal rupture and bleeding as is gaining favor over open surgical repair.