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These aneurysms have a female predilection&#46; RAAs are associated with hypertension in up to 73&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Hypotheses on the pathophysiological basis of hypertension include microembolization from the aneurysm&#44; coexisting renal artery stenosis&#44; compression or kinking of the renal artery or its branches&#44; and turbulent flow&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Management decisions should be based on patient age and gender&#44; anticipated pregnancy&#44; severity of hypertension and anatomic features of the aneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Pregnant women&#44; female patients of childbearing age&#44; and patients with evidence of embolization are candidates for surgical or endovascular intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other causes for such interventions are symptomatic aneurysms &#40;flank pain&#44; hypertension&#44; hematuria&#41;&#44; rapidly expanding aneurysms and those larger than 2<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The choice of treatment of RAAs is determined by the anatomic location of the aneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although stent grafts and stent-plus-coil embolization techniques are successful for most simple RAAs&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> complex aneurysms beyond the bifurcation of the main renal artery&#44; or those involving major arterial branches&#44; may require extracorporal arterial reconstruction followed by autotransplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the case of a 23-year-old Caucasian man diagnosed with hypertension three years previously and no other relevant personal or family history&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Non-invasive 24-hour blood pressure monitoring revealed stage I hypertension &#40;mean daytime blood pressure 156&#47;87<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; Hormonal and imaging studies were also performed for etiologic diagnosis of his hypertension&#44; as well as a captopril test&#44; which was positive for renovascular hypertension&#46; Following this result&#44; renal angiography was performed&#44; which revealed&#44; bilaterally&#44; two renal arteries&#44; and in addition&#44; to the right&#44; depending on the superior artery&#44; three saccular aneurysms 14<span class="elsevierStyleHsp" style=""></span>mm&#44; 6<span class="elsevierStyleHsp" style=""></span>mm and 3&#46;5<span class="elsevierStyleHsp" style=""></span>mm in size&#46; The largest aneurysm appeared to compress the lower polar artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The aneurysms were treated with placement of a polytetrafluoroethylene &#40;PTFE&#41;-coated stent&#44; in order to prevent expansion and rupture of the aneurysms and to treat the hypertension&#46; Digital subtraction angiography was performed using a right femoral approach&#46; A 65<span class="elsevierStyleHsp" style=""></span>cm 4F sheath was introduced&#44; and the right renal artery was engaged with a 4F Cobra catheter and a 0&#46;014-inch hydrophilic guidewire&#46; Aneurysm morphology was assessed using conventional angiography and flat-panel computed tomography&#46; Stent diameter and length were determined from a three-dimensional flat-panel rotational angiography data set&#46; After administration of 5000 IU of heparin&#44; the aneurysm was crossed with the guidewire and catheter&#46; The wire was exchanged through the same catheter with a 0&#46;014-inch guidewire&#46; Finally&#44; a 6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>22-mm covered Atrium stent was deployed&#44; bridging the aneurysm and covering the artery&#44; resulting in successful exclusion of the aneurysms &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>&#41;&#46; The patient was admitted the day before the procedure and was discharged the day after&#44; medicated with 100<span class="elsevierStyleHsp" style=""></span>mg aspirin and 75<span class="elsevierStyleHsp" style=""></span>mg clopidogrel&#47;day&#44; as dual antiplatelet therapy&#46; Ten months after the procedure the patient was asymptomatic&#44; with normal blood pressure and without antihypertensive therapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The development and wide dissemination of non-invasive imaging techniques has led to the diagnosis of an increasing number of new cases of secondary hypertension&#46; Cases formerly designated as essential hypertension now have a specific diagnosis&#44; often with the possibility of resolution&#44; avoiding the effects of high blood pressure and the chronic use of antihypertensive therapy&#46; The clinical relevance of incidentally discovered RAAs remains the subject of debate&#44; with uncertainty regarding the threshold for intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> However&#44; there is a consensus that repair should be performed in pregnant women or those of childbearing age&#44; in cases with evidence of embolization&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in symptomatic aneurysms &#40;flank pain&#44; hypertension&#44; hematuria&#41;&#44; and in rapidly expanding aneurysms and those larger than 2<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The case described concerns a young male diagnosed with hypertension three years earlier and under antihypertensive therapy&#46; English et al&#46; reported the surgical outcome of 62 patients treated for RAAs&#44; 89&#37; of whom had hypertension&#59; most of these &#40;75&#37;&#41; experienced beneficial blood pressure response in a mean follow-up of 48 months after RAA repair&#44; including 21&#37; who became normotensive off all medications&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Other surgical series report similar rates of improvement in hypertension following RAA treatment in conjunction with fewer antihypertensive medications&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a> Due to the clinical repercussions of aneurysms in this patient and the expected benefits of the intervention&#44; there was no doubt regarding the need for treatment&#44; leading to a multidisciplinary discussion on the best form of approach&#46; Three general approaches have been described for RAA treatment&#58; &#40;1&#41; surgery with either <span class="elsevierStyleItalic">in situ</span> aneurysmectomy and bypass with an autologous conduit&#44; or nephrectomy<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#59; &#40;2&#41; transcatheter embolization<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#59; or &#40;3&#41; endovascular exclusion by stent graft&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The angiographic pattern of RAAs and their feeding artery or arteries help to determine the optimal method of treatment&#46; Three main types of RAAs are described&#58; saccular RAAs arising from either the main renal artery or a large segmental branch &#40;type 1&#41;&#44; which are the most common&#59; fusiform aneurysms &#40;type 2&#41;&#59; and intralobar aneurysms &#40;type 3&#41;&#44; which arise from small segmental arteries that supply a limited portion of the renal parenchyma&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Type 1 RAAs can be successfully treated with stent graft implantation&#59; type 2 are best treated by a surgical approach&#44; while type 3 may be treated with catheter-directed embolization using microcoils&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; morbidity and long recovery periods persist in cases of open surgical repair&#44; and aortorenal bypass occlusions and unplanned nephrectomies occur even in the largest series&#46; Additionally&#44; some patients may not be candidates for surgical repair because of comorbidities that preclude surgery or because of complex aneurysm morphology or location&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Recently&#44; laparoscopic surgery has been proposed as a minimally invasive alternative to open surgical RAA repair&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The percutaneous treatment of RAAs with covered stents&#44; increasingly accepted as safe and effective&#44; also offers several advantages compared to traditional surgical therapy due to its minimally invasive nature&#59; it may be a safe therapeutic alternative to surgery in cases with an appropriate artery caliber proximal and distal to the aneurysm&#44; and with the aneurysm neck not located close to a branching point of the renal artery&#46; The treatment of RAAs with covered stents has some limitations because of the inflexibility of the devices&#44; preventing application in small and tortuous vessels&#44; and due to the risk of thrombosis and stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Different embolic techniques &#40;such as selective coil embolization&#41;&#44; remodeling techniques &#40;including balloon and stent-assisted coiling&#41;&#44; and embolization with liquid embolic agents &#40;such as glue or onyx&#41; exist and in selected patients represent the first-line treatment option for RAAs&#46; However&#44; in these techniques also it is sometimes necessary to perform a parent-vessel occlusion to treat the aneurysm with some degree of renal parenchyma compromise&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the case presented&#44; a multidisciplinary consensus led to a conservative approach with implantation of a PTFE-coated stent in which the aneurysms involved a large-caliber vessel&#44; the aneurysms were easily accessible&#44; and there were no collateral vessels of significant size in the area of deployment of the stent&#46; On the other hand&#44; coil embolization of an important vessel may result in non-target embolization or coil migration or delayed recanalization of the aneurysm&#46; The risk of occlusion reinforces the importance of maintaining dual antiplatelet therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The procedure was uneventful and the final images show the successful exclusion of the aneurysms&#46; Ten months after the procedure&#44; the absence of symptoms and normalization of blood pressure show the success of the intervention&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The endovascular approach has demonstrated safety and effectiveness in treating selected patients with renovascular hypertension&#46; Due to low procedure-related mortality and morbidity&#44; percutaneous renal interventions have been incorporated into common practice despite the lack of evidence from randomized studies to support their efficacy over the long term&#46; The cases described in the literature indicate good prognosis in hypertension control and exclusion of aneurysms&#44; and the present case demonstrates the efficacy and safety of the percutaneous approach in treating RAAs&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            1 => "Aneurisma da art&#233;ria renal"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal artery aneurysms are a rare cause of secondary hypertension&#46; Endovascular treatment with a polytetrafluoroethylene &#40;PTFE&#41;-coated stent can exclude aneurysms and treat hypertension&#46; We report the case of a 23-year-old man with hypertension diagnosed three years earlier and in whom renal angiography revealed three aneurysms involving the right renal artery&#46; A covered stent was implanted&#44; resulting in successful exclusion of the aneurysm&#46; Ten months after the procedure the patient is asymptomatic and with normal blood pressure without antihypertensive therapy&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os aneurismas da art&#233;ria renal representam uma causa rara de hipertens&#227;o secund&#225;ria&#46; O tratamento endovascular com <span class="elsevierStyleItalic">stent</span> revestido por politetrafluoretileno &#40;PTFE&#41; consiste numa abordagem que permite excluir os aneurismas e tratar a hipertens&#227;o&#46; Apresentamos o caso de um jovem de 23 anos&#44; com o diagn&#243;stico de hipertens&#227;o h&#225; tr&#234;s anos e cuja angiografia renal mostrou tr&#234;s aneurismas na depend&#234;ncia da art&#233;ria renal direita&#46; Procedeu-se &#224; implanta&#231;&#227;o de um <span class="elsevierStyleItalic">stent</span> revestido por PTFE com a exclus&#227;o bem sucedida dos aneurismas&#46; Dez meses ap&#243;s o procedimento o doente est&#225; assintom&#225;tico e com valores normais de tens&#227;o arterial sem terap&#234;utica anti hipertensora&#46;</p>"
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Case report
Renal artery aneurysm: An endovascular treatment for a rare cause of hypertension
Aneurisma da artéria renal – tratamento endovascular para uma causa rara de hipertensão
Nádia Moreiraa,
Corresponding author
nadia.moreira5@gmail.com

Corresponding author.
, Mariano Pêgoa, Vítor Carvalheirob, Alfredo Agostinhob, Paulo Donatob, João Pegoc, Maria João Ferreiraa, Luís Providênciaa
a Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
b Serviço de Imagiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
c Serviço de Patologia Clínica, Hospitais da Universidade de Coimbra, Coimbra, Portugal
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These aneurysms have a female predilection&#46; RAAs are associated with hypertension in up to 73&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Hypotheses on the pathophysiological basis of hypertension include microembolization from the aneurysm&#44; coexisting renal artery stenosis&#44; compression or kinking of the renal artery or its branches&#44; and turbulent flow&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Management decisions should be based on patient age and gender&#44; anticipated pregnancy&#44; severity of hypertension and anatomic features of the aneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Pregnant women&#44; female patients of childbearing age&#44; and patients with evidence of embolization are candidates for surgical or endovascular intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other causes for such interventions are symptomatic aneurysms &#40;flank pain&#44; hypertension&#44; hematuria&#41;&#44; rapidly expanding aneurysms and those larger than 2<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The choice of treatment of RAAs is determined by the anatomic location of the aneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although stent grafts and stent-plus-coil embolization techniques are successful for most simple RAAs&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> complex aneurysms beyond the bifurcation of the main renal artery&#44; or those involving major arterial branches&#44; may require extracorporal arterial reconstruction followed by autotransplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the case of a 23-year-old Caucasian man diagnosed with hypertension three years previously and no other relevant personal or family history&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Non-invasive 24-hour blood pressure monitoring revealed stage I hypertension &#40;mean daytime blood pressure 156&#47;87<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; Hormonal and imaging studies were also performed for etiologic diagnosis of his hypertension&#44; as well as a captopril test&#44; which was positive for renovascular hypertension&#46; Following this result&#44; renal angiography was performed&#44; which revealed&#44; bilaterally&#44; two renal arteries&#44; and in addition&#44; to the right&#44; depending on the superior artery&#44; three saccular aneurysms 14<span class="elsevierStyleHsp" style=""></span>mm&#44; 6<span class="elsevierStyleHsp" style=""></span>mm and 3&#46;5<span class="elsevierStyleHsp" style=""></span>mm in size&#46; The largest aneurysm appeared to compress the lower polar artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The aneurysms were treated with placement of a polytetrafluoroethylene &#40;PTFE&#41;-coated stent&#44; in order to prevent expansion and rupture of the aneurysms and to treat the hypertension&#46; Digital subtraction angiography was performed using a right femoral approach&#46; A 65<span class="elsevierStyleHsp" style=""></span>cm 4F sheath was introduced&#44; and the right renal artery was engaged with a 4F Cobra catheter and a 0&#46;014-inch hydrophilic guidewire&#46; Aneurysm morphology was assessed using conventional angiography and flat-panel computed tomography&#46; Stent diameter and length were determined from a three-dimensional flat-panel rotational angiography data set&#46; After administration of 5000 IU of heparin&#44; the aneurysm was crossed with the guidewire and catheter&#46; The wire was exchanged through the same catheter with a 0&#46;014-inch guidewire&#46; Finally&#44; a 6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>22-mm covered Atrium stent was deployed&#44; bridging the aneurysm and covering the artery&#44; resulting in successful exclusion of the aneurysms &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>&#41;&#46; The patient was admitted the day before the procedure and was discharged the day after&#44; medicated with 100<span class="elsevierStyleHsp" style=""></span>mg aspirin and 75<span class="elsevierStyleHsp" style=""></span>mg clopidogrel&#47;day&#44; as dual antiplatelet therapy&#46; Ten months after the procedure the patient was asymptomatic&#44; with normal blood pressure and without antihypertensive therapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The development and wide dissemination of non-invasive imaging techniques has led to the diagnosis of an increasing number of new cases of secondary hypertension&#46; Cases formerly designated as essential hypertension now have a specific diagnosis&#44; often with the possibility of resolution&#44; avoiding the effects of high blood pressure and the chronic use of antihypertensive therapy&#46; The clinical relevance of incidentally discovered RAAs remains the subject of debate&#44; with uncertainty regarding the threshold for intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> However&#44; there is a consensus that repair should be performed in pregnant women or those of childbearing age&#44; in cases with evidence of embolization&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in symptomatic aneurysms &#40;flank pain&#44; hypertension&#44; hematuria&#41;&#44; and in rapidly expanding aneurysms and those larger than 2<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The case described concerns a young male diagnosed with hypertension three years earlier and under antihypertensive therapy&#46; English et al&#46; reported the surgical outcome of 62 patients treated for RAAs&#44; 89&#37; of whom had hypertension&#59; most of these &#40;75&#37;&#41; experienced beneficial blood pressure response in a mean follow-up of 48 months after RAA repair&#44; including 21&#37; who became normotensive off all medications&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Other surgical series report similar rates of improvement in hypertension following RAA treatment in conjunction with fewer antihypertensive medications&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a> Due to the clinical repercussions of aneurysms in this patient and the expected benefits of the intervention&#44; there was no doubt regarding the need for treatment&#44; leading to a multidisciplinary discussion on the best form of approach&#46; Three general approaches have been described for RAA treatment&#58; &#40;1&#41; surgery with either <span class="elsevierStyleItalic">in situ</span> aneurysmectomy and bypass with an autologous conduit&#44; or nephrectomy<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#59; &#40;2&#41; transcatheter embolization<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#59; or &#40;3&#41; endovascular exclusion by stent graft&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The angiographic pattern of RAAs and their feeding artery or arteries help to determine the optimal method of treatment&#46; Three main types of RAAs are described&#58; saccular RAAs arising from either the main renal artery or a large segmental branch &#40;type 1&#41;&#44; which are the most common&#59; fusiform aneurysms &#40;type 2&#41;&#59; and intralobar aneurysms &#40;type 3&#41;&#44; which arise from small segmental arteries that supply a limited portion of the renal parenchyma&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Type 1 RAAs can be successfully treated with stent graft implantation&#59; type 2 are best treated by a surgical approach&#44; while type 3 may be treated with catheter-directed embolization using microcoils&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; morbidity and long recovery periods persist in cases of open surgical repair&#44; and aortorenal bypass occlusions and unplanned nephrectomies occur even in the largest series&#46; Additionally&#44; some patients may not be candidates for surgical repair because of comorbidities that preclude surgery or because of complex aneurysm morphology or location&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Recently&#44; laparoscopic surgery has been proposed as a minimally invasive alternative to open surgical RAA repair&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The percutaneous treatment of RAAs with covered stents&#44; increasingly accepted as safe and effective&#44; also offers several advantages compared to traditional surgical therapy due to its minimally invasive nature&#59; it may be a safe therapeutic alternative to surgery in cases with an appropriate artery caliber proximal and distal to the aneurysm&#44; and with the aneurysm neck not located close to a branching point of the renal artery&#46; The treatment of RAAs with covered stents has some limitations because of the inflexibility of the devices&#44; preventing application in small and tortuous vessels&#44; and due to the risk of thrombosis and stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Different embolic techniques &#40;such as selective coil embolization&#41;&#44; remodeling techniques &#40;including balloon and stent-assisted coiling&#41;&#44; and embolization with liquid embolic agents &#40;such as glue or onyx&#41; exist and in selected patients represent the first-line treatment option for RAAs&#46; However&#44; in these techniques also it is sometimes necessary to perform a parent-vessel occlusion to treat the aneurysm with some degree of renal parenchyma compromise&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the case presented&#44; a multidisciplinary consensus led to a conservative approach with implantation of a PTFE-coated stent in which the aneurysms involved a large-caliber vessel&#44; the aneurysms were easily accessible&#44; and there were no collateral vessels of significant size in the area of deployment of the stent&#46; On the other hand&#44; coil embolization of an important vessel may result in non-target embolization or coil migration or delayed recanalization of the aneurysm&#46; The risk of occlusion reinforces the importance of maintaining dual antiplatelet therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The procedure was uneventful and the final images show the successful exclusion of the aneurysms&#46; Ten months after the procedure&#44; the absence of symptoms and normalization of blood pressure show the success of the intervention&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The endovascular approach has demonstrated safety and effectiveness in treating selected patients with renovascular hypertension&#46; Due to low procedure-related mortality and morbidity&#44; percutaneous renal interventions have been incorporated into common practice despite the lack of evidence from randomized studies to support their efficacy over the long term&#46; The cases described in the literature indicate good prognosis in hypertension control and exclusion of aneurysms&#44; and the present case demonstrates the efficacy and safety of the percutaneous approach in treating RAAs&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal artery aneurysms are a rare cause of secondary hypertension&#46; Endovascular treatment with a polytetrafluoroethylene &#40;PTFE&#41;-coated stent can exclude aneurysms and treat hypertension&#46; We report the case of a 23-year-old man with hypertension diagnosed three years earlier and in whom renal angiography revealed three aneurysms involving the right renal artery&#46; A covered stent was implanted&#44; resulting in successful exclusion of the aneurysm&#46; Ten months after the procedure the patient is asymptomatic and with normal blood pressure without antihypertensive therapy&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os aneurismas da art&#233;ria renal representam uma causa rara de hipertens&#227;o secund&#225;ria&#46; O tratamento endovascular com <span class="elsevierStyleItalic">stent</span> revestido por politetrafluoretileno &#40;PTFE&#41; consiste numa abordagem que permite excluir os aneurismas e tratar a hipertens&#227;o&#46; Apresentamos o caso de um jovem de 23 anos&#44; com o diagn&#243;stico de hipertens&#227;o h&#225; tr&#234;s anos e cuja angiografia renal mostrou tr&#234;s aneurismas na depend&#234;ncia da art&#233;ria renal direita&#46; Procedeu-se &#224; implanta&#231;&#227;o de um <span class="elsevierStyleItalic">stent</span> revestido por PTFE com a exclus&#227;o bem sucedida dos aneurismas&#46; Dez meses ap&#243;s o procedimento o doente est&#225; assintom&#225;tico e com valores normais de tens&#227;o arterial sem terap&#234;utica anti hipertensora&#46;</p>"
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ISSN: 21742049
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