Open Repair of a Renal Artery Aneurysm with Hypogastric Artery Autograft and Hypothermic Perfusion Preservation

A 32-year-old woman presented with a one-year history of mild abdominal pain in the left upper quadrant and a palpable pulsatile abdominal mass on physical examination. The results of laboratory investigations, including serum urea and creatinine levels, were unremarkable. Contrast enhanced computed tomography (CT) showed a large left renal artery aneurysm, measuring 5,0 cm by 3,5 cm, but no evidence of renal perfusion alterations or other vascular abnormalities (Figure 1). She had been previously submitted to an unsuccessful endovascular approach with intention to treat the aneurysm and preserve left renal perfusion. Because she was young and in good health our purpose was to preserve left renal function and an open repair was adopted. The patient underwent a laparotomy with midline incision and the left kidney, left renal vein and artery were circumferentially mobilized from surrounding tissues. To permit a much better exposure, left renal vein and artery were clamped and transected while the ureter was left intact and the ex-situ reconstruction was performed on the body wall [1-3].