Fig. 2. Hand injection of contrast in the aneurysm helps to delineate the wide-mouth and branch artery arising from the aneurysm.

A 50-year-old Indian/Mexican male liver transplant candidate with known Hepatitis C cirrhosis was asymptomatic. A CT scan obtained for an elevated alpha-fetal protein level (45.1 mg/dL) demonstrated cavernous transformation of the portal vein, multiple splenorenal varices, and a cirrhotic appearing liver consistent with portal hypertension. No other significant findings were present. A repeat CT scan obtained 7 months later for an increasing AFP level (50.1 mg/dL) demonstrated a new, large right renal artery aneurysm measuring 3 x 2.5 cm. The 3D CT angiogram better illustrates the anatomic relationship of the arteries at the bifurcation (Fig. 1). Selective right renal arteriography showed wide-mouthed aneurysm at the renal artery bifurcation at the hilum and a branch artery arising from the aneurysm (Fig. 2). The surgeons were reluctant to operate with the intent of preserving this patient’s transplant candidate status.

The branch artery arising from the aneurysm was selected with a Tracker-18 microcatheter and embolized with multiple 0.018 inch Tornado coil (Fig 3). A 6 x 20 mm Wallstent was deployed over the mouth of the aneurysm (Fig. 3). The interstices of the stent were crossed with a Tracker-10 microcatheter and the aneurysm was packed with numerous 0.010 inch 3D-shape GDC coils (Fig. 4). A follow-up ultrasound demonstrates no flow within the aneurysm and preserved renal artery flow (Fig. 5).

Questions:

1) What are the possible etiologies for the renal aneurysm?

Fig. 3. Multiple 0.018 inch Tornado coils deployed in the branch artery arising from the aneurysm followed by placement of a 6 x 20 mm Wallstent across the mouth of the aneurysm.

Fig. 4. 0.010 inch 3D-shape GDC coils were packed into the aneurysm via a Tracker-10 catheter introduced through the interstices of the Wallstent.

Fig. 5. Follow-up ultrasound 2 weeks later demonstrates no flow within the aneurysm but preserved renal artery arterial flow.