Laparoscopic Repair of a Renal Artery Aneurysm with Partial Nephrectomy in a Patient with a Synchronous Primary Renal Malignancy and Fibromuscular Dysplasia
Allan M Conway, Khalil Qato, Bobby Alexander, Andrew Fishman, Michael Grasso, Alfio Carroccio
Lenox Hill Heart & Vascular Institute of New York, New York, NY
INTRODUCTION: We report the case of a 70-year old female who was found to have a 2cm right renal artery aneurysm and fibromuscular dysplasia during the work-up of microscopic hematuria. During pre-operative evaluation a 3cm right upper pole primary renal malignancy, and a rise in the serum creatinine from 0.80 to 2.31-mg/dL over the preceding 2-year period were noted.
METHODS: Our primary goals were maximal renal preservation, cure of the renal malignancy and repair of the aneurysm. Options for repair included; a laparoscopic nephrectomy, open partial nephrectomy with aneurysm repair, laparoscopic partial nephrectomy with coil embolization of the renal artery aneurysm, and laparoscopic partial nephrectomy and aneurysm repair. After consideration of various management options we elected to proceed with a laparoscopic partial nephrectomy and simultaneous laparoscopic aneurysm repair. An extraperitoneal technique was used for the entire procedure. The aneurysm was dissected free from the surrounding tissues and then resected. The artery was repaired primarily and patency confirmed with intra-operative duplex ultrasonography. A right upper pole guillotine nephrectomy was then performed to excise the tumor.
RESULTS: The patient did well post operatively. At follow-up duplex ultrasonography revealed patent flow within the renal artery, normal resistive indices and laboratory tests demonstrated improvement in renal function.
CONCLUSIONS: Herein, we demonstrate with intra-operative video recording an extraperitoneal laparoscopic approach to treating a saccular renal artery aneurysm in a patient with fibromuscular dysplasia and a right upper pole renal malignancy. We describe our collaborative approach to a complex patient to achieve a successful outcome.
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