Renal Artery Aneurysms in the Inpatient Setting


      The risk of rupture of renal artery aneurysms (RAAs) remains undefined. A recent paper from the Vascular Low-Frequency Disease Consortium (VLFDC) identified only 3 ruptures in 760 patients. However, over 80% of patients in the VLFDC study were treated at large academic centers, which may not reflect the pattern of care of RAAs nationwide. Thus, the purpose of this study was to evaluate the pattern of nonelective versus elective surgery requiring inpatient admission for RAAs, including nephrectomies, and their outcomes using a national database.


      The National Inpatient Sample (NIS) database from 2012 to 2018 was utilized. Patients with a primary diagnosis of RAAs were identified using ICD-9 and ICD-10 codes. Ruptured RAAs (rRAAs) were identified utilizing surrogate ICD codes. The primary outcome variables for this study were proportion of RAAs requiring non-elective surgery and in-hospital mortality.


      A total of 590 inpatient admissions for RAA were identified with 554 procedures at 467 hospitals across the country. Of the 590 inpatient admissions, 380 (64.4%) admissions were deemed nonelective. There was an increasing proportion of nonelective admissions over the study period. The overall rate of nephrectomies was 7.1% (n = 42). In-hospital mortality rate for the cohort was 1.4% (n = 8) with no differences in in-hospital mortality in the elective versus nonelective setting (1.0% vs. 1.6%; P = 0.718). In the nonelective setting, patients requiring a nephrectomy (n = 23) had significantly higher rates of in-hospital mortality compared those not requiring a nephrectomy (8.7% vs. 1.1%, P = 0.045). rRAA (n = 50) patients had significantly higher in-hospital mortality compared to the remainder of the cohort (6.0% vs. 0.9%, P = 0.024). rRAA patients were also more likely to undergo a nephrectomy compared to the remainder of the cohort (16.0% vs. 6.3%, P = 0.019).


      These data demonstrate that treatment of RAAs are primarily done in the nonelective setting with a high proportion of ruptures, which could continue to rise as the threshold for repair has decreased.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Coleman D.M.
        • Stanley J.C.
        Renal artery aneurysms.
        J Vasc Surg. 2015; 62: 779-785
        • Stanley J.C.
        • Rhodes E.L.
        • Gewertz B.L.
        • et al.
        Renal artery aneurysms: significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations.
        Arch Surg. 1975; 110: 1327-1333
        • Cerny J.C.
        • Chang C.Y.
        • Fry W.J.
        Renal artery aneurysms.
        Arch Surg. 1968; 96: 653-663
        • Henke P.K.
        • Cardneau J.D.
        • Welling T.H.
        • et al.
        Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients.
        Ann Surg. 2001; 234: 454-463
        • Lawrence P.F.
        • Baril D.T.
        • Woo K.
        Investigating uncommon vascular diseases using the vascular low frequency disease Consortium.
        J Vasc Surg. 2020; 72: 1005-1010
        • Klausner J.Q.
        • Lawrence P.F.
        • Harlander-Locke M.P.
        • et al.
        The contemporary management of renal artery aneurysms.
        J Vasc Surg. 2015; 61: 978-984.e1
        • Chaer R.A.
        • Abularrage C.J.
        • Coleman D.M.
        • et al.
        The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.
        J Vasc Surg. 2020; 72: 3S-39S
        • Janeway M.G.
        • Sanchez S.E.
        • Chen Q.
        • et al.
        Association of race, health insurance status, and household income with location and outcomes of ambulatory surgery among adult patients in 2 US States.
        JAMA Surg. 2020; 155: 1123-1131
        • Calfee R.P.
        • Shah C.M.
        • Canham C.D.
        • et al.
        The influence of insurance status on access to and utilization of a tertiary hand surgery referral center.
        J Bone Joint Surg Am. 2012; 94: 2177-2184
        • Venkatesh A.K.
        • Chou S.C.
        • Li S.X.
        • et al.
        Association between insurance status and access to hospital care in emergency department disposition.
        JAMA Intern Med. 2019; 179: 686-693
        • Kent K.C.
        Clinical practice. Abdominal aortic aneurysms.
        N Engl J Med. 2014; 371: 2101-2108
        • Warner C.J.
        • Roddy S.P.
        • Chang B.B.
        • et al.
        Regionalization of emergent vascular surgery for patients with ruptured AAA improves outcomes.
        Ann Surg. 2016; 264: 538-541
        • Hill J.S.
        • McPhee J.T.
        • Messina L.M.
        • et al.
        Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era.
        J Vasc Surg. 2008; 48: 29-36
        • Buck D.B.
        • Curran T.
        • McCallum J.C.
        • et al.
        Management and outcomes of isolated renal artery aneurysms in the endovascular era.
        J Vasc Surg. 2016; 63: 77-81
        • Hislop S.J.
        • Patel S.A.
        • Abt P.L.
        • et al.
        Therapy of renal artery aneurysms in New York State: outcomes of patients undergoing open and endovascular repair.
        Ann Vasc Surg. 2009; 23: 194-200