Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm – case report

PURPOSE: Renal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%). CASE REPORT: A 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation. CONCLUSIONS: The authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm.