3
Recommendations
Renal Artery Aneurysm (RAA)
Recommendation
Grade/
LOE
1. Diagnosis and evaluation
1.1 In patients who are thought to have RAA, we recommend CTA as the
diagnostic tool of choice, with 1-mm thick sections if available.
1-B
1.2 In patients who are thought to have RAA and have increased radiation
exposure risks or renal insufficiency, we recommend non-contrast-
enhanced MRA to establish the diagnosis.
Technical remark: Non-contrast-enhanced MRA is best suited to children
and women of childbearing potential or those who have contraindications
to CTA or MRA contrast materials (ie pregnancy, renal insufficiency, or
gadolinium contrast material allerg y).
1-C
1.3 If preoperative planning and recognition of distal renal artery branches
cannot be adequately assessed on conventional cross-sectional imaging
(CTA), we recommend the use of catheter-based angiography.
1-C
2. Size criteria and alternative indications for intervention
2.1 In patients with noncomplicated RAA of acceptable operative risk, we
suggest treatment for aneurysm size >3 cm.
2-C
2.2 We recommend emergent intervention for any size RAA resulting in
patient symptoms or rupture.
1-B
2.3 In patients of childbearing potential with noncomplicated RAA of
acceptable operative risk, we suggest treatment regardless of size.
2-B
2.4 In patients with medically refractory hypertension and functionally
important renal artery stenosis, we suggest treatment regardless of size.
2-C
3. Treatment options
3.1 We suggest daily antiplatelet therapy (ie, low-dose aspirin) for patients
with RAA.
2-C
3.2 We suggest open surgical reconstructive techniques for the elective
repair of most RAAs in patients with acceptable operative risk.
2-B
3.3 We suggest ex vivo repair and autotransplantation for complex distal
branch aneurysms over nephrectomy when it is technically feasible.
2-B
3.4 We suggest endovascular techniques for the elective repair of
anatomically appropriate RAAs to include stent gra exclusion of main
RAAs in patients with poor operative risk and embolization of distal
and parenchymal aneurysms.
2-B
3.5 We suggest consideration of laparoscopic and robotic techniques as an
interventional alternative based on institutional resources and surgeon
experience with minimally invasive techniques.
2-C
