Kidney autotransplantation for renovascular hypertension due to hilar renal artery aneurysm: India's first in a child.

Abstract

A boy in middle childhood with recurrent haematuria and refractory hypertension for 3.5 years was referred to our hospital with CT findings of a large right renal artery aneurysm. Following an unsuccessful endovascular intervention, a multidisciplinary team approach was set up, as well as a plan for right nephrectomy, complete excision of the aneurysm, reconstruction of the cut end of the branches of the renal artery using internal iliac artery (IIA) 'Y' graft followed by autotransplantation. The IIA 'Y' graft was then anastomosed with the external iliac artery, and the renal vein was anastomosed with the external iliac vein. Blood loss was minimal. Postoperatively, the patient had an uneventful recovery and was discharged on postoperative day 7 with restored renal anatomy, preserved normal renal mass and eliminated risk of rupture and aneurysmal complications. A follow-up at the end of 6 months showed improved quality of life; the child has been attending school, playing and living with a low dose of one antihypertensive medication.