Renal artery aneurysms are an uncommon vascular entity and are more likely to affect younger patients without significant atherosclerotic risk factors as compared to patients with renal artery occlusive disease.

The natural history and clinical significance of renal artery aneurysms (RAAs) are uncertain; hence, the indications for management remain controversial. Risk of rupture is often proposed as a rationale for RAA repair; however, rupture risk appears low. Embolization from RAA may contribute to renal infarction with hematuria and flank pain, but most RAAs remain free of these clinical signs and symptoms. Recently, the contribution of RAA to secondary hypertension has been emphasized, even though the causative mechanism is often unclear. Diagnosis is often made incidentally but arteriography is essential for good operative planning. Patient selection criteria for RAA repair have commonly related patient anatomic features of the aneurysm to risk of rupture. Some authors have considered absolute size as a sole criterion for RAA treatment. Repair is recommended for RAA >1.0 cm when hypertension is present and for RAA between 1.5 to 2.0 cm when no hypertension is present. Fusiform shape and calcification have been also suggested as protective against rupture; however, several series have demonstrated no correlation between these characteristics and rupture risk. Young...continua a leggere