Renal artery pseudoaneurysm

Last revised by Mohamed Saber on 19 Feb 2021

Renal artery pseudoaneurysms are uncommon vascular finding, with the majority occuring after a renal intervention.

A renal artery pseudoaneurysm differs from a renal artery true aneurysm (as might occur in fibromuscular dysplasia) in that it does not involve all three layers of the arterial wall, but rather involves an outpouching through one or more layers of the wall.

Renal artery pseudoaneuryms occur most commonly following an intervention, such as partial nephrectomy or percutaneous nephrostomy. A pseudoaneurysm may complicate renal transplantation. Rarely, they may occur from infection (possibly after renal artery stent placement).

  • focal dilatation of the renal artery 
  • if large, there may be a yin-yang swirling within the pseudoaneurysm
  • focal dilatation off the renal artery on a contrast-enhanced study
  • abnormal well-defined saccular outpouching off the renal artery during a selective renal artery angiogram

Treatment decisions are individualized to the patient; women who plan to become pregnant are considered to be at higher risk. If large (>2 cm), asymptomatic, and a branch vessel it can be treated with coil embolization 4 (although aneurysms smaller than 2 cm have ruptured). Main renal artery pseudoaneurysms may require a stent or surgical ligation.

If symptomatic, more aggressive therapy may be indicated, including surgery.

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Cases and figures

  • Case 1: right renal artery pseudoaneurysm
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  • Case 2: post nephrostomy tube placement
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  • Case 3: iatrogenic- post partial nephrectomy
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  • Case 4
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