Aneurysm of the renal artery. A vascular reconstructive approach.

Twenty-one patients were shown roentgenographically to have one or more renal artery aneurysm. Twelve patients had concomitant renal arterial stenosis. Other than aortography and selective renal angiography, ring-shaped calcification on the abdominal roentgenogram was the only helpful guideline to proper diagnosis. Ninety percent of the patients were hypertensive despite treatment with specific antihypertensive medications. The average preoperative blood pressure was 184/118 mm Hg. A selection of angioplastic and bypass techniques allowed resection of renal artery aneurysms and preservation of the intact kidneys in 19 of 21 patients. Arterial pressure was reduced to an average of 142/85 mm Hg at the time of discharge from the hospital and to 150/87 mm Hg, 1 to 11 years after surgery. Nephrectomy is rarely indicated as the primary operation for aneurysms of the renal artery since direct vascular reconstruction can be successfully performed in most of these patients.