Management strategies for giant renal artery aneurysms: a systematic review and case report

BACKGROUND: Renal artery aneurysm (RAA) is a rare but potentially life-threatening condition. The definition of giant RAA is ≥ 50 mm. Although often asymptomatic, the risk of rupture increases significantly with size, posing a substantial threat. Giant RAAs have historically tended to be repaired using open surgery. At present, intravascular technology has become an alternative solution due to its advantage of less invasiveness. OBJECTIVE: This study seeks to present a rare case of successful endovascular embolization for a giant renal aneurysm (RAA), while also systematically reviewing recent literature to compare the outcomes of surgical and endovascular treatments for giant RAA, and to describe management strategies for giant renal hemangiomas. METHODS: We describe a case of a young man treated by endovascular coil embolization and had a large RAA. After the PRISMA guidelines were followed, a systematic literature review was carried out, initially identifying 347 studies. After screening and full-text review, 35 studies met the inclusion criteria for comparative analysis of patient demographics, treatment modalities, and outcomes. RESULTS: A total of 35 studies, encompassing 35 patients with giant renal artery aneurysms, were included. The mean age was 53 years (15-88 years). Endovascular therapy was performed in 12 cases, while 20 patients underwent surgical management; 2 patients received combined treatment and 1 was treated conservatively. Overall, symptom improvement and complication profiles were reported descriptively across both surgical and endovascular treatments. CONCLUSION: Managing giant renal artery aneurysms necessitates a personalized, multifaceted approach. Intravascular therapy represents a feasible and minimally invasive option for selected patients with suitable anatomical structures and stable hemodynamics, while open surgery remains indispensable for complex anatomy or rupture. A multidisciplinary approach, guided by precise assessment of aneurysm morphology and renal function, is essential for optimal outcomes.