[PP.LB03.01] RENOVASCULAR HYPERTENSION AS INITIAL MANIFESTATION OF SOLITARY RENAL ARTERY ANEURYSM IN A YOUNG GREEK MALE

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Abstract

Objective:

To present a rare case of branch renal artery aneurysm focusing on:

Design and method:

A 35 year old Greek male with no past medical history presents with de novo stage 3 hypertension with average readings of 220/130mmHg. Basic laboratory studies revealed dyslipidaimia, normal renal function and normal albumin excretion levels. Plain kidney-ureter-bladder radiographic imaging showed renal calcification.

Design and method:

The diagnostic workup for secondary hypertension included a computed tomography angiography of renal blood vessels and suprarenal glands which has shown a renal artery aneurysm.

Design and method:

Despite normal perfusion was observed, the renogram showed a 8% reduction of the left kidney function.

Design and method:

A thoracic computed tomography idetified no other abnormal vessels.

Design and method:

The magnetic angyography illustrated a 5 cm branch renal artery aneurysm with a wall thrombus, anterior to the left kidney.

Design and method:

Immediate surgical repair was performed with ligation of the vessel and resection of the aneurysm.

Results:

Postoperatively the patient presented clinical improvement (blood pressure around 120/80mmHg) with two antihypertensive agents, including an inhibitor of the renin-angiotensin-aldosterone system.

Results:

The dyslipidaimia was treated with statin and ezetimibe.

Results:

A renogram performed 3 months after the surgical procedure showed a 22% decline on the left kidney function. This further reduction might be attributed to the aneurysmectomy and angioplastic renal artery branch closure. Left renal function remained stable for the next five years. During that time frame the patient did not present with any major cardiovascular complications.

Conclusions:

Our results are compatible with the Coral Trial and with other studies as the Renal Artery Aneurysms-A 35 year Clinical Experience. In the last one, the surgical benefit was a decline in blood pressure while taking fewer antihypertensive agents and the maintenance of the renal function in selected cases.

Conclusions:

Our patient had an excellent long-term clinical outcome associated with renal function maintenance and normalization of blood pressure.

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