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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (2): 396-399. doi: 10.19723/j.issn.1671-167X.2025.02.028

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Renal autotransplantation for the treatment of complex renal aneurysm in a child: A case report

Lei YU1, Wenbo YANG1, Yufan YANG2, Qiang WANG1,△()   

  1. 1. Department of Urology, Peking University People's Hospital, Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
    2. School of Nursing, Peking University, Beijing 100191, China
  • Received:2024-09-04 Online:2025-04-18 Published:2025-04-12
  • Contact: Qiang WANG E-mail:wq301135@163.com

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Abstract:

Renal autotransplantation (RA) offers significant technical advantages for the management of certain complex renal vascular diseases, such as complex renal aneurysms and renal artery malformations. This report describes a case of a 5-year-old child with a complex left renal artery aneurysm combined with multiple aneurysms. The child was admitted to Peking University People's Hospital in December 2023 due to a one-year history of intermittent abdominal pain, with an abdominal mass detected in the past month. Computed tomography angiography(CTA) revealed multiple vascular anomalies, including: (1) a left renal artery aneurysm, (2) an abdominal aortic aneurysm, and (3) a right iliac artery aneurysm. After a comprehensive evaluation of these findings, the surgical team developed a treatment plan that involved the excision of the left renal artery aneurysm, autotransplantation of the left kidney, and resection of the abdominal aortic aneurysm with an artificial vascular catheterization. During surgery, it was discovered that the left renal artery anatomy was highly complex. The artery had two primary branches, along with an additional polar artery located at the lower pole. The aneurysm was identified at the distal end of the renal artery trunk, with a pronounced bulging at the intersection between the main renal artery trunk and its secondary branches. Due to these structural complexities, the team decided to use an ex vivo surgical approach to repair the aneurysm. Ex vivo repair involves temporarily removing the kidney from the body to repair the renal artery aneurysm with enhanced precision, enabling the surgical team to meticulously reconstruct the complex vascular architecture without the constraints of in vivo manipulation. The ex vivo repair of the renal artery aneurysm was successful, allowing for accurate vascular reconstruction and avoiding potential intraoperative complications. Following the reconstruction, the kidney was autotransplanted back into the child's body, and blood flow was effectively restored to the organ. The therapeutic outcome was excellent, with the child experiencing no postoperative complications. The patient recovered well and was discharged from the hospital in stable condition. This case underscores the value of renal autotransplantation combined with ex vivo repair for pediatric patients with complicated renal artery aneurysms. Through this report, we aim to provide insights and considerations for the surgical treatment of similar cases in children with complex renal vascular anatomy.

Key words: Transplantation, autologous, Renal artery, Aortic aneurysm, Abdominal, Complex renal aneurysm, Ex vivo surgery

CLC Number: 

  • R726.9

Figure 1

Preoperative CTA finding Preoperative computed tomography angiography (CTA) showed a pike-shaped mass in the medial aspect of the upper pole of the left kidney, measuring approximately 3.2 cm×3.1 cm×3.8 cm (shown by white arrow); the abdominal aorta and the right common iliac artery showed irregular aneurysmal dilatation, with a cross-sectional size of 4.1 cm×2.5 cm (shown by red arrow)."

Figure 2

Abdominal aortic aneurysm and renal artery aneurysm formation in the upper pole of the left kidney seen intraoperatively A, intraoperative view of aneurysmal dilatation of the abdominal aorta (arrowed); B, intraoperative view of a spindle-shaped exophytic mass in the medial aspect of the upper pole of the left kidney (arrowed)."

Figure 3

Anatomy and diagram of the kidney on the bench A, renal artery aneurysm protruding from the main renal artery at the location of its intersection with the secondary branches of the renal artery; B, schematic diagram: ①abdominal aorta, ②inferior pole branch of renal artery, ③renal artery trunk, ④renal artery aneurysm with thrombosis, ⑤secondary branches of the renal artery 2, ⑥secondary branches of the renal artery 1."

Figure 4

Arterial reconstruction, renal autotransplantation surgical procedures and schematic diagrams A, arterial reconstruction intraoperative view: ① inferior pole branch of renal artery, ② secondary branches of the renal artery 1, ③ secondary branches of the renal artery 2; B, schematic diagram of arterial reconstruction: ① renal artery trunk, ② inferior pole branch of renal artery, ③ residual lumen after resection of renal artery aneurysm, ④ both ends of the main renal artery are anastomosed end to end with each of the two secondary branches of the renal artery; C, intraoperative view of renal autotransplantation: ① autologous kidney, ② end-to-end anastomosis of ureter with autologous ureter, ③ end-to-side anastomosis of the renal vein to the external iliac vein, ④ end-to-side anastomosis of the inferior polar branch renal artery to the external iliac artery, ⑤ end-to-side anastomosis of the main renal artery to the left internal iliac artery; D, schematic diagram of renal autotransplantation: ① left common iliac artery, ② left internal iliac artery, ③ end-to-side anastomosis of the renal vein to the external iliac vein, ④ end-to-side anastomosis of the inferior polar branch renal artery to the external iliac artery, ⑤ left external iliac artery."

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