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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 4  |  Page : 627-630
Combined Aneurysms of the Main Renal and Celiac Arteries: An Unusual Association

1 Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
2 Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3 Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Cell Biology/Surgery, University of Alabama at Birmingham, AL, USA

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Celiac artery aneurysm (CAA) is a rare condition, which occasionally occurs in association with such visceral aneurysms as splenic, common hepatic, left hepatic, supe­rior mesenteric and renal arteries. We describe our observation of a patient with CAA and bilateral main renal artery aneurysm. To the best of our knowledge, a combination of these visceral arterial aneurysms has not been reported previously. The available literature on this topic is briefly reviewed.

Keywords: Celiac, Aneurysm, Renal, Artery

How to cite this article:
Bavil AS, Ghabili K, Rahimi-Ardabili B, Shoja MM, Tubbs R S. Combined Aneurysms of the Main Renal and Celiac Arteries: An Unusual Association. Saudi J Kidney Dis Transpl 2008;19:627-30

How to cite this URL:
Bavil AS, Ghabili K, Rahimi-Ardabili B, Shoja MM, Tubbs R S. Combined Aneurysms of the Main Renal and Celiac Arteries: An Unusual Association. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2022 Aug 10];19:627-30. Available from: https://www.sjkdt.org/text.asp?2008/19/4/627/41326

   Introduction Top

Celiac artery aneurysms (CAAs) are one of the rarest forms of splanchnic artery aneu­rysms, which are usually found incidentally during angiographic examination. [1],[2],[3],[4] The pre­valence of renal artery aneurysms (RAAs) in the general population reportedly varies between 0.01 and 1%. [5],[6] RAAs account for about 20% of all visceral aneurysms. [6] How­ever, this prevalence has recently increased because of advanced imaging techniques such as ultrasonography, contrast-enhanced com­puted tomography, and angiography. The most serious complication of CAAs and RAAs is their rupture. [3],[4],[6] The co-existence of CAA and RAAs is seemingly very rare. We report our observations of a patient with combined aneurysms of the celiac and bilateral main renal arteries. We hope that information herein might be useful for clinicians and radiologists.

   Case Report Top

A 41-year-old woman from a rural area was admitted to our central university hos­pital with an increasing epigastric pain for two weeks. The past medical history was remarkable for a recent onset hypertension. Physical examination revealed generalized abdominal tenderness without rigidity or guar­ding. No bruit was found over the abdo­minal aorta and renal arteries. The periphe­ral pulses were symmetrically detectable. Initial laboratory findings included a white blood cell count of 19.6 × 10 3 , a hematocrit of 49.4% and hemoglobin of 15.9 gm/dl. Prothrombin and partial thromboplastin times were 12.5 and 26 seconds, respectively. Blood urea and creatinine levels were with­in normal limit. Urinalysis was unremarkable. Abdominal doppler sonography revealed a­neurysms of the celiac and right and left main renal arteries of 6×4, 3×2 and 2×2 cm diameter, respectively. A subsequent contrast­enhanced abdominal computed tomography showed a collection at the origin of the ce­liac artery with a peripheral hypodense re­gion consistent with a dissecting aneurysm. The patient underwent a digital subtraction angiography, which confirmed a celiac artery aneurysm (CAA) as well as bilateral aneu­rysms of the main renal artery [Figure 1]. Subsequently, a laparatomy was performed and while controlling the abdominal aorta, the aneurysm at the origin of the celiac artery was repaired. The patient was discharged in a favorable clinical condition. She was sche­duled to have follow-up visits by a nephro­logist for her RAAs.

   Discussion Top

The estimated incidence of CAA ranges between 0.005% and 0.01%. [4] Unlike patients with other visceral aneurysms, about two third of patients diagnosed with CAA are men. [2],[4] CAAs may be associated with abdo­minal aortic aneurysms and other splanchnic artery aneurysms in about 20 and 50% of ca­ses, respectively. [4],[7],[8],[9] Wagner and colleagues [10] reported a patient with multiple ruptured aneurysms of the celiac, splenic, common hepatic, left hepatic and superior mesenteric arteries. Marwali and Rossi [11] described com­bined celiac, cerebral and renal artery aneu­rysms in a patient with segmental renal atro­phy. In the present case, the renal function was normal and there were no gross changes in the morphology of the kidneys. CAAs may be asymptomatic or may present with non-specific abdominal pain. [4] The rupture of CAA carries a high risk of mortality. [4] The present patient underwent a laparatomy and repair of the CAA due to a symptomatic and ruptured aneurysm. McMullan and col­leagues 4 mentioned early intervention as be­ing essential in most of the patients with CAA. [4] However, indications for surgical in­tervention are usually limited to symptomatic aneurysms, enlarging aneurysms, aneurysms more than 3 to 4 times the normal vessel diameter and calcified aneurysms larger than 3 cm. [4]

Based on autopsy findings, the incidence of RAA is estimated to be 0.01%. [5] How­ever, in patients with renovascular hyper­tension, angiography may reveal such aneu­rysms in up to 2.5% of cases. [12] Although bilateral occurrence of RAA is found in ~20% of patients [5] , the involvement of both main renal arteries, rather than their segmen­tal branches, is seemingly unusual. Gandini and colleagues [13] reported a patient with bi­lateral main renal artery aneurysm who was treated with percutaneous graft-stent place­ment. However, their patient had impaired renal function, which was not seen in our patient. RAA is usually asymptomatic and is detected incidentally while looking for other intra-abdominal pathologies. [14] Occasionally, the patients may present with hypertension, flank pain and hematuria. Indications for intervention are RAA greater than 2 cm in diameter, dissecting aneurysms, renal ische­mia and dysfunction, symptomatic aneurysms and pregnancy. [5],[6] In the present report, uri­nalysis and renal function tests were normal and the patient was scheduled to have follow­up visits by a nephrologist for her RAAs.

The association of celiac and main renal artery aneurysms in the present case repre­sents an unusual clinical scenario, which may warrant considerations by vascular surgeons, radiologists and nephrologists. This report may also highlight the importance of surveying the abdominal aorta and its branches when a splanchnic aneurysm is detected.

   References Top

1.Connell JM, Han DC. Celiac artery aneu­rysms: a case report and review of the literature. Am Surg 2006;72(8):746-9.  Back to cited text no. 1    
2.Graham LM, Stanley JC, Whitehouse WM Jr, et al. Celiac artery aneurysms: historic (1745-1949) versus contemporary (1950- 1984) differences in etiology and clinical importance. J Vasc Surg 1985;2(5):757-64.  Back to cited text no. 2    
3.Katsuno A, Onda M, Tajiri T, et al. Celiac artery aneurysm: a case evaluated pre­operatively with three-dimensional computed tomographic angiography. J Nippon Med Sch 2001;68(5):444-6.  Back to cited text no. 3    
4.McMullan DM, McBride M, Livesay JJ, Dougherty KG, Krajcer Z. Celiac artery aneurysm: A case report. Tex Heart Inst J 2006;33(2):235-40.  Back to cited text no. 4    
5.Tehrani H, Otero CA, Sawaged R, et al. Renal artery aneurysm. 2005; . htm.  Back to cited text no. 5    
6.Shonai T, Koito K, Ichimura T, Hirokawa N, Sakata K, Hareyama M. Renal artery aneurysm: Evaluation with color Doppler ultrasonography before and after percu­taneous transarterial embolization. J Ultra­sound Med 2000;19(4):277-80.  Back to cited text no. 6    
7.Graham LM, Stanley JC, Whitehouse WM Jr, et al. Syphilitic aneurysm of celiac artery. Am J Sci 1943;206:453-7.  Back to cited text no. 7    
8.Phillips WS, Macmanus Q, Lefrak EA. Celiac artery aneurysms: case reports. Va Med Q 1991;118(4):235-8.  Back to cited text no. 8    
9.Vohra R, Carr HM, Welch M, Tait WF, Durrans D, Walker MG. Management of coeliac artery aneurysms. Br J Surg 1991; 78(11):1373-5.  Back to cited text no. 9    
10.Wagner WH, Allins AD, Treiman RL, et al. Ruptured visceral artery aneurysms. Ann Vasc Surg 1997;11(4):342-7.  Back to cited text no. 10    
11.Marwali MR, Rossi NF. Ask-Upmark kidney associated with renal and extrarenal arterial aneurysms. Am J Kidney Dis 1999;33(4):e4.  Back to cited text no. 11    
12.Stanley JC, Rhodes EL, Gewertz BL, Chang CY, Walter JF, Fry WJ. Renal artery aneurysms: significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations. Arch Surg 1975;110(11): 1327-33.  Back to cited text no. 12    
13.Gandini R, Spinelli A, Pampana E, Fabiano S, Pendenza G, Simonetti G. Bilateral renal artery aneurysm: Percutaneous treatment with stent-graft placement. Cardiovasc Intervent Radiol 2006;29(5):875-8.  Back to cited text no. 13    
14.Bastounis E, Pikoulis E, Georgopoulos S, Alexiou D, Leppaniemi A, Boulafendis D. Surgery for renal artery aneurysms: a combined series of two large centers. Eur Urol 1998;33(1):22-7.  Back to cited text no. 14    

Correspondence Address:
Mohammadali M Shoja
No. 9, Bonbast-e-Jhaleh, Qatran-e-Shomaly Ave. Tabriz, 51738
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Source of Support: None, Conflict of Interest: None

PMID: 18580025

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