In Situ and Ex Situ Renal Artery Aneurysmectomy In the Congenital Solitary Kidney. : Report of two Cases

Abstract

Herein are reported on two cases of renal artery aneurysms in congenital solitary kidneys treated by the different surgical methods; namely in situ and ex situ aneurysmectomy. The first case, 33 year old housewife, survived after rupture of a large non-calcified aneurysm locating at the main artery of her congenital solitary kidney and was transferred to our facility. In situ aneurysmectomy and end-to-end anastomosis of the renal artery was tried but was troubled by dense hematoma embedding the renal hilar region and resulted in mild stenosis of the anastomosic site. However, the patient has been keeping normal renal function and normotension two years postoperatively. The second case; 55 year old housewife had multiple calcified and non-calcified aneurysms locating at the main, first, second and third bifurcation of her congenital solitary kidney with maximum non-calcified one measuring 30 mm in diameter. Besides renal artery aneurysms in solitary kidney, she had other congenital abnormality as uterus bicornus, absent left iliac vein andd two small aneurysms in cerebral artery region. Due to aggravating right backache suggesting urgent rupture of her aneurysms, ex situ aneurysmectomy was performed. After flushing by icecold hyperosmolar intracellular electrolyte solution, five aneurysms were excised and renal arterial tree was reconstructed by angioplastic technique including patchgraft and pair-of-pants anastomosis. Without dividing her ureter, the kidney was transplanted to her right iliac fossa in upsidedown fashion after 6 hours' ischemia. She recovered from transient postoperative acute renal failure and has been doing fairly well one year postoperatively. Several discussions regarding renal artery aneurysm in solitary kidney including associated congenital abnormality and surgical hazards were presented. Ex situ surgery and use of hyperosmolar electrolyte solution were recommended as safe methods of aneurysmectomy in these circumstances.