45 The Contemporary Management of Renal Artery Aneurysms скачать в хорошем качестве

45 The Contemporary Management of Renal Artery Aneurysms

#RenalArteryAneurysm #RAA #VascularSurgery #JournalOfVascularSurgery #MedicalResearch #AneurysmRepair #ObservationVsSurgery #GuidelineShift #VascularLowFrequencyDiseaseConsortium This video summarises a landmark 2015 Journal of Vascular Surgery study by the Vascular Low Frequency Disease Consortium on Renal Artery Aneurysms (RAAs). Drawing from a textbook chapter, it explores the condition and its management. Defined as a more than 1.5x bulge in the renal artery wall involving all layers, RAAs are rare (0.1%) but increasingly found incidentally on scans. The large study examined 865 RAAs in 760 patients. Notably, 75% were asymptomatic. Symptoms in others included hypertension (10%), flank pain (6%), blood in urine (4%), or abdominal pain (2%). Average size was 1.5 cm; most were unilateral, right-sided, saccular, and often calcified or at the bifurcation. A crucial finding was the extremely low rupture risk (0.03%). Every rupture occurred only in aneurysms more than 3 cm, with none under 3 cm rupturing in the study. This strongly suggests the prior 2 cm threshold for intervention was overly cautious for many asymptomatic cases. RAAs typically grow slowly (0.086 cm/year), and calcification doesn't prevent growth. Management included elective repair (241 RAAs, 25% patients) or observation (624 RAAs). Repair was usually for symptoms or size more than 2 cm and involved open or endovascular methods. Repair had significant risks (10% major complications). For hypertension patients, repair cured it in 32% and improved it in 26%. The observation group had no acute complications over an average 49-month follow-up. Based on the low rupture risk under 3 cm, the study proposed a 3 cm threshold for considering intervention in asymptomatic cases. This study influenced new Society for Vascular Surgery guidelines towards recommending treatment primarily for non-complicated RAAs over 3 cm. Despite retrospective limitations, it provides robust evidence challenging older practices and highlights the need for updated guidelines based on modern data. Key takeaways: Asymptomatic RAAs seem less dangerous, rupture risk is low below 3 cm, and the recommended treatment threshold for uncomplicated cases is shifting towards 3 cm.