ENDOVASCULAR MANAGEMENT OF AN ASYMPTOMATIC INCIDENTAL NONRUPTURED GIANT RENAL ARTERY ANEURYSM IN PREGNANCY
Dr Pooja Krishnaswamy1
1Monash Health, Clayton, Australia
Society of Vascular Surgery guidelines recommend renal artery aneurysms in patients of childbearing age should be treated to prevent the increased risk of rupture and negate complexity of repair during pregnancy. Rupture of renal artery aneurysms in pregnancy have significantly higher morbidity and mortality rates for both the mother and foetus.
A 5.4cm right renal artery aneurysm was found incidentally on an antenatal screening ultrasound at 14 weeks gestation in a 37-year-old G2P1 female. She had a past medical history of hypertension with normal renal function. A multidisciplinary approach involving obstetric nephrology, interventional radiologists, neurointerventional radiologists and vascular surgeons was required. Surgical repair via ex vivo renal artery repair and auto transplantation was too complex due to the size and location of the aneurysm and high risk for the foetus. The patient declined both nephrectomy during pregnancy and termination of pregnancy. Prophylactic coiling of the aneurysm and stenting of the renal artery was performed in the second trimester as the risk of rupture incidence is higher in the third trimester. Although the intervention only excluded 95% of the aneurysm while sacrificing the posteromedial branch during stenting, the patient carried the pregnancy without further complications and with normal renal function, and delivered full term.
This case describes prophylactic combined endovascular coiling and stenting of an incidental, asymptomatic unruptured 5.4cm large renal artery aneurysm during second trimester of pregnancy in a 37-year-old female.
Biography:
Dr Krishnaswamy is a dedicated, passionate unaccredited Vascular Registrar currently working with with Monash Health.