Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1984 Aug;200(2):134–146. doi: 10.1097/00000658-198408000-00004

Renal artery dissection.

B M Smith, G W Holcomb 3rd, R E Richie, R H Dean
PMCID: PMC1250435  PMID: 6465968

Abstract

Renal artery dissections are stenotic or occlusive lesions most often observed in hypertensive patients with underlying atherosclerosis or fibromuscular disease. Acute dissections may present spontaneously, as a complication of diagnostic or therapeutic angiography or as an agonal event associated with overwhelming systemic illness. Chronic dissections may produce renovascular hypertension or be entirely asymptomatic. Fourteen renal artery dissections have been encountered in nine patients treated at Vanderbilt University Medical Center during the past decade. Eleven dissections have been found in seven patients with renovascular hypertension. Seven of these dissections were chronic (six functional, one silent) and four acute (two spontaneous, two secondary to angiography). Three agonal dissections were found in two additional patients postmortem: one at autopsy and bilateral dissections found at the time of cadaveric donor nephrectomy. Ten bypass procedures, including five complex branch reconstructions of which three were performed ex vivo, have been performed with 100% immediate patency and maintenance or improvement of renal function. Long-term follow-up of these patients has shown sustained patency of the reconstructed renal arteries, excellent blood pressure control, and normal renal function in all. Nephrectomy has not been required and there have been no associated deaths. Seventy-seven additional renal artery dissections in 72 patients collected from previous reports have been analyzed. Patient survival (55/72, 76.4%) and preservation of the involved kidney in surviving patients (26/55, 47.3%) were low in these earlier series. In addition, renal failure was associated with 59% of the deaths. The lethality of renal artery dissections and the ease and success of revascularization, which preserves renal function and ameliorates associated renovascular hypertension, emphasize the need for an aggressive approach to the recognition and treatment of this entity. Therapy should be directed toward arterial reconstructions and the preservation of functioning renal tissue.

Full text

PDF
134

Images in this article

136FIG. 1A.
on p.136
137FIG. 2A.
on p.137
138FIG. 5.
on p.138
138FIG. 6.
on p.138
138FIG. 7.
on p.138
139FIG. 9.
on p.139
140FIG. 10.
on p.140
141FIG. 11.
on p.141

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BOSTICK W. L., GILFILLAN R. S., SMART W. R. Dissecting aneurysm of the renal artery. AMA Arch Surg. 1956 Nov;73(5):737–740. doi: 10.1001/archsurg.1956.01280050005002. [DOI] [PubMed] [Google Scholar]
  2. BOYD J. F., WATSON A. J. Dissecting aneurysm due to trauma. Scott Med J. 1956 Oct;1(10):326–329. doi: 10.1177/003693305600101005. [DOI] [PubMed] [Google Scholar]
  3. Busuttil R. W., Abou-Zamzam A. M., Machleder H. I. Collagenase activity of the human aorta. A comparison of patients with and without abdominal aortic aneurysms. Arch Surg. 1980 Nov;115(11):1373–1378. doi: 10.1001/archsurg.1980.01380110105016. [DOI] [PubMed] [Google Scholar]
  4. Cicuto K. P., McLean G. K., Oleaga J. A., Freiman D. B., Grossman R. A., Ring E. J. Renal artery stenosis: anatomic classification for percutaneous transluminal angioplasty. AJR Am J Roentgenol. 1981 Sep;137(3):599–601. doi: 10.2214/ajr.137.3.599. [DOI] [PubMed] [Google Scholar]
  5. Cummings K. B., Lecky J. W., Kaufman J. J. Renal artery aneurysms and hypertension. J Urol. 1973 Feb;109(2):144–148. doi: 10.1016/s0022-5347(17)60374-4. [DOI] [PubMed] [Google Scholar]
  6. Dean R. H., Kieffer R. W., Smith B. M., Oates J. A., Nadeau J. H., Hollifield J. W., DuPont W. D. Renovascular hypertension: anatomic and renal function changes during drug therapy. Arch Surg. 1981 Nov;116(11):1408–1415. doi: 10.1001/archsurg.1981.01380230032005. [DOI] [PubMed] [Google Scholar]
  7. Dean R. H., Lawson J. D., Hollifield J. W., Shack R. B., Polterauer P., Rhamy R. K. Revascularization of the poorly functioning kidney. Surgery. 1979 Jan;85(1):44–52. [PubMed] [Google Scholar]
  8. Englund G. W. Primary dissecting aneurysm of the renal artery. Report of a case and review of the literature. Am J Clin Pathol. 1966 Apr;45(4):472–479. doi: 10.1093/ajcp/45.4.472. [DOI] [PubMed] [Google Scholar]
  9. FOORD A. G., LEWIS R. D. Primary dissecting aneurysms of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch Pathol. 1959 Nov;68:553–577. [PubMed] [Google Scholar]
  10. Gill W. B., Cole A. T., Wong R. J. Renovascular hypertension developing as a complication of selective renal arteriography. J Urol. 1972 Jun;107(6):922–924. doi: 10.1016/s0022-5347(17)61172-8. [DOI] [PubMed] [Google Scholar]
  11. HENRY L., BURKE W. D. Isolated dissecting aneurysms of the renal artery. Angiology. 1963 Jun;14:269–276. doi: 10.1177/000331976301400601. [DOI] [PubMed] [Google Scholar]
  12. Hare W. S., Kincaid-Smith P. Dissecting aneurysm of the renal artery. Radiology. 1970 Nov;97(2):255–263. doi: 10.1148/97.2.255. [DOI] [PubMed] [Google Scholar]
  13. Harrison E. G., Jr, Hunt J. C., Bernatz P. E. Morphology of fibromuscular dysplasia of the renal artery in renovascular hypertension. Am J Med. 1967 Jul;43(1):97–112. doi: 10.1016/0002-9343(67)90151-9. [DOI] [PubMed] [Google Scholar]
  14. Hertzer N. R., Montie J. E., Hall P. M., Banowsky L. H. Revascularization of the kidney after occlusion of the aorta and both renal arteries. Surgery. 1976 Jan;79(1):52–56. [PubMed] [Google Scholar]
  15. Kaufman J. J., Coulson W. F., Lecky J. W., Popjak G. Primary dissecting aneurysm of renal artery: report of a case causing reversible renal hypertension. Ann Surg. 1973 Mar;177(3):259–263. doi: 10.1097/00000658-197303000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kincaid O. W., Davis G. D., Hallermann F. J., Hunt J. C. Fibromuscular dysplasia of the renal arteries. Arteriographic features, classification, and observations on natural history of the disease. Am J Roentgenol Radium Ther Nucl Med. 1968 Oct;104(2):271–282. [PubMed] [Google Scholar]
  17. Lawson J. D., Hollifield J. H., Foster J. H., Rhamy R. K., Dean R. H. Hypertension secondary to complete occlusion of the renal artery. Am Surg. 1978 Oct;44(10):642–649. [PubMed] [Google Scholar]
  18. Lohse J. R., Shore R. M., Belzer F. O. Acute renal artery occlusion: the role of collateral circulation. Arch Surg. 1982 Jun;117(6):801–804. doi: 10.1001/archsurg.1982.01380300043010. [DOI] [PubMed] [Google Scholar]
  19. Magilligan D. J., Jr, DeWeese J. A., May A. G., Rob C. G. The occluded renal artery. Surgery. 1975 Dec;78(6):730–738. [PubMed] [Google Scholar]
  20. McCormack L. J., Poutasse E. F., Meaney T. F., Noto T. J., Jr, Dustan H. P. A pathologic-arteriographic correlation of renal arterial disease. Am Heart J. 1966 Aug;72(2):188–198. doi: 10.1016/0002-8703(66)90442-x. [DOI] [PubMed] [Google Scholar]
  21. Poutasse E. F. Renal artery aneurysms: their natural history and surgery. J Urol. 1966 Mar;95(3):297–306. doi: 10.1016/S0022-5347(17)63451-7. [DOI] [PubMed] [Google Scholar]
  22. Reiss M. D., Bookstein J. J., Bleifer K. H. Radiologic aspects of renovascular hypertension. 4. Arteriographic complications. JAMA. 1972 Jul 24;221(4):375–378. doi: 10.1001/jama.221.4.375. [DOI] [PubMed] [Google Scholar]
  23. Rosenblum W. I. Isolated dissecting aneurysm of the renal artery. J Urol. 1966 Feb;95(2):135–138. doi: 10.1016/S0022-5347(17)63422-0. [DOI] [PubMed] [Google Scholar]
  24. Schwarten D. E. Transluminal angioplasty of renal artery stenosis: 70 experiences. AJR Am J Roentgenol. 1980 Nov;135(5):969–974. doi: 10.2214/ajr.135.5.969. [DOI] [PubMed] [Google Scholar]
  25. Shabanah F., Connolly J., Martin D. C. Acute renal artery occlusion. Surg Gynecol Obstet. 1970 Sep;131(3):489–494. [PubMed] [Google Scholar]
  26. Sos T. A., Pickering T. G., Sniderman K., Saddekni S., Case D. B., Silane M. F., Vaughan E. D., Jr, Laragh J. H. Percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma or fibromuscular dysplasia. N Engl J Med. 1983 Aug 4;309(5):274–279. doi: 10.1056/NEJM198308043090504. [DOI] [PubMed] [Google Scholar]
  27. Stanley J. C., Rhodes E. L., Gewertz B. L., Chang C. Y., Walter J. F., Fry W. J. Renal artery aneurysms. Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations. Arch Surg. 1975 Nov;110(11):1327–1333. doi: 10.1001/archsurg.1975.01360170067009. [DOI] [PubMed] [Google Scholar]
  28. TUQAN N. A. PRIMARY DISSECTING ANEURYSM OF THE RENAL ARTERY. J Pathol Bacteriol. 1965 Jan;89:369–370. doi: 10.1002/path.1700890140. [DOI] [PubMed] [Google Scholar]
  29. Talner L. B., McLaughlin A. P., Bookstein J. J. Renal artery dissection: a complication of catheter arteriography. Radiology. 1975 Nov;117(2):291–295. doi: 10.1148/117.2.291. [DOI] [PubMed] [Google Scholar]
  30. Tham G., Ekelund L., Herrlin K., Lindstedt E. L., Olin T., Bergentz S. E. Renal artery aneurysms. Natural history and prognosis. Ann Surg. 1983 Mar;197(3):348–352. doi: 10.1097/00000658-198303000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Thomas J. M., Pfaff W. W. Acute anuria secondary to renal artery stenosis. Ann Surg. 1976 Mar;183(3):293–295. doi: 10.1097/00000658-197603000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Thomas T. V. Management of acute and subacute renal artery occlusion. Am Heart J. 1970 Sep;80(3):430–431. doi: 10.1016/0002-8703(70)90110-9. [DOI] [PubMed] [Google Scholar]
  33. Towne J. B., Bernhard V. M. Revascularization of the ischemic kidney. Arch Surg. 1978 Feb;113(2):216–218. doi: 10.1001/archsurg.1978.01370140106024. [DOI] [PubMed] [Google Scholar]
  34. Zinman L., Libertino J. A. Revascularization of the chronic totally occluded renal artery with restoration of renal function. J Urol. 1977 Oct;118(4):517–521. doi: 10.1016/s0022-5347(17)58091-x. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES