in Our experience we propose a robotic assisted Surgical treatment: Robot-assisted laparoscopic repair of renal artery aneurysms.

Giuliànotti PC et al.

J Vasc Surg. 2010 Apr;51(4):842-9.

For patients who have enlarging aneurysms, but are considered too high risk for open or laparoscopic surgery due to medical co-morbidities, endovascular coil embolization may be considered a low-risk treatment option.

Another option for a patient in which emoblization is felt not to be appropriate would be to perform laparoscopic nephrectomy, back table reconstruction and renal autotransplantation in an effort to preserve nephron mass.

I agree with you , but, In our experience by robotic procedure, we have performed a reconstruction without back table surgery.

Recently, endovascular techniques have gained its popularity in the treatment of visceral aneurysm. I agree with Mr. Michael Alexander that for high risk patients, the endovascular approach offer minimal invasive treatment with subsequent low morbidity and mortality. For those with main renal artery involvement, covered stent and multilayer stent can be utilized. The latter one can preserve important branches near the aneurysm. For those with intra-parenchymal involvement or more distal branches aneurysm, simple coil embolization, stent-assisted coil embolization or coil embolization of the parent artery aneurysm have acceptable outcomes.

Dear A Muradi

Thank you for you answer, but in your opinion what are the patients who are candidates for surgery and what type of surgery?

We use endovascular tecnics also. I agree Mr. Alexander that for high risk patients, the endovascular coice is more appropriate. For those patiets with renal arter involvement multilayer stent covered used. For more distal Aneurysmatic branch segment coil embolization is good coice. 

Dear All,

I  agree with Mr. Alexander , Muradi and Tarhan, but at this moment i do  prefer endovascular coil embolization or covered stent instead of multilayer to treat renal artery aneurism. Some reports are ambiguous about multilayer results.

I would like to ask Ms. A. Lombardi to send her suggestion of paper ?

Giuliànotti PC et al.

J Vasc Surg. 2010 Apr;51(4):842-9.

My email address : [email protected]

Dear  Paulo and all ,

I agree with  you that, routinely the best treatment  is the endovascular approach , especially for high risk pts. But I ask you: in your opinion, what's the best type of treatment in this case? A 57 old years  Female  with the solitary  kidney presented a   28 mm renal aneurysm of first order of bifurcation . In this case is possible an endovascular approach without an elevated risk of artery occlusion and renal infarction? 

Dear a.Lombardi,

In my opinion you are absolutely right, in this case there is an elevated risk of artery occlusion.

So we agree that endovascular approach nowadays should  be a good option routinaly but not for all patients.

Nice discussion,

thank you A. Lombardi for the topic. Robot-assisted laparoscopic repair of renal artery aneurysms (RAAs) is a very interesting technique. Nowadays treatment of RAAs remains very controversial. Not only the right type but also when to operate or not to operate are under discussion. I would like to add just few question to the discussion:

- Indications: do you ever treat RAAs with diameter > 20 mm or do you consider also other factors such as saccular morphology, native vessel size, expectation of pregnancy?

- about 90% of renal artery aneurisms (RAA) are due to fibromuscular dysplasia and, according to the largest series published, they occur in patients with a mean age between 50 and 60 yo, so, I don't have notice a large cohort of "high surgical risk"  among these patients;

- what do you think about coil embolization in so called "wide neck aneurysms"? I read a paper about the successful use of neurointerventional coils in a 12-mm neck RAA. Have you got any experience with these devices?

- I have not experience with multilayer stents yet but many colleagues think they are very stiff. How do they adapt in the tortuous anatomy of RAA?

Dear All ,

I do prefer Endovascular aproach , embolization of coils with stent protection to avoid