Laparoscopic nephrectomy for ex-vivo correction of renal artery aneurism and auto transplant

Abstract

INTRODUCTION AND OBJECTIVES: Renal artery aneurism are a rare condition, with a prevalence of 0.09% of the population. The outcomes and clinical management of this patients depend on the presence of symptoms and subsequent risk of rupture. Most patients are managed by endovascular techniques, but difficult cases may present a challenge to urologists. METHODS: We present a case of a 35 year old female, history of high blood pressure with the diagnosis of a left renal artery aneurism with a diameter of 27 mm. The patient was evaluated by vascular surgery, was unsuitable for endovascular treatment and was submitted to a laparoscopic left nephrectomy with correction of the aneurism ex-vivo and the kidney was transplanted to the left iliac region. RESULTS: Operative time was 150 minutes and the warm ischemia time was 160 seconds. Blood loss was estimated in 80 mL with a hematocrit drop of 2% post operative. Drainage and vesical catheter were removed at day 2 and 6 post-operative, respectively. Post operative creatinine clearance was comparable to the pre operative (Post - 95 vs. Pre - 98 mL/min/1.73m2) The follow up is 15 months and the patients has a functioning kidney and had a normalization of the blood pressure. CONCLUSIONS: In experienced centers, laparoscopic nephrectomy with subsequent autotransplantion can be a safe and effective option in the management of specific conditions. This case presents a possible way to treat renal artery aneurisms that can’t be managed by endovascular procedures.