Endovascular Coil Occlusion of Right Renal Artery Aneurysm with Embolization of the Right Kidney: A Case Report

<i>Introduction:</i> Renal artery aneurysm is rare and has reported incidence of 0.09% of the general population. The occurrence of a giant renal artery aneurysm from the main renal artery has even been more rarely reported. Endovascular intervention is ideal for the treatment of patients with vascular anomalies of the renal artery especially in cases where surgical morbidity is high. This article reports our experience in the treatment of giant complex renal artery aneurysm by endovascular techniques in a young man with poor performance status. <i>Case report: </i>A 25-year-old male with no significant past medical history presented with progressively worsening abdominal pain, generalized body swelling, progressive abdominal distension, low blood pressure and difficulty in breathing. He had poor performance status with suboptimal oxygen saturation probably due to splinting of the diaphragm from the progressive abdominal distension and was immediately transferred to intensive care unit for close monitoring. Ultrasound scan revealed a huge right renal mass with turbulent internal flow paving way for suspicion of a giant renal artery aneurysm. Subsequent CT angiogram confirmed a giant saccular aneurysm emanating from the proximal main right renal artery with evidence of surrounding hematoma signifying recent rupture. There was significant mass effect on adjacent structures including the inferior vena cava which was nearly completely collapsed. Following a multidisciplinary discussion with interventional radiology, he was transferred to a facility equipped with a catheterization laboratory. <i>Procedure:</i> Real-time ultrasound was used to gain access into the right radial artery and a 6French sheath placed. A 5 Fr Vertebral curve catheter was advanced successfully from the right radial artery access into the right renal artery over a 0.035 guidewire. Following arteriograms and confirmation of site of aneurysm being the proximal main renal artery, considerations for treatment included stent graft placement or sacrifice of the right renal artery. Due to unavailability of an appropriately sized stent graft, we elected to sacrifice the right renal artery. Through the 5 French catheter, multiple 0.035 detachable and nondetectable coils were deployed proximal to the aneurysm sac and distal to the aneurysm sac to completely occlude the right renal artery. Post embolization arteriogram showed complete exclusion of flow within the aneurysm sac. <i>Conclusion:</i> Endovascular embolization as a minimal invasive technique is an ideal treatment option for the treatment of giant complex renal artery aneurysms especially in patients in a poor clinical state.