False Aneurysm Formation following Cutting Balloon Angioplasty in the Renal Artery of a Child

Abstract

Purpose:

To report the fortuitous discovery of a false aneurysm 7 years after cutting balloon angioplasty for severe renal artery fibromuscular dysplasia in a child.

Case Report:

A 3-year-old girl with neurofibromatosis was referred to our institution because of high blood pressure (220/160 mmHg). Computed tomography identified coarctation of the aorta and severe bilateral renal artery stenoses. The coarctation was successfully resected. One month later, bilateral renal artery angioplasty with a 3-mm balloon was unsatisfactory, so a second angioplasty one month later was done with a 3.25-mm cutting balloon. This procedure was complicated by a minimal arterial rupture, which resolved spontaneously after inflation of a regular balloon. Normal blood pressure was restored. The child was lost to follow-up until 7 years later, when recurrent hypertension (200 mmHg systolic) prompted referral again. Arteriography showed a very severe stenosis on the right side and a 30-mm false aneurysm of the left renal artery at the rupture site. Due to her age, the patient underwent surgery, which brought the blood pressure under control.

Conclusions:

False aneurysm of the renal arteries is a rare complication of percutaneous angioplasty. In a child, the cutting balloon would appear to be contraindicated for concentric dysplastic stenoses that are resistant to regular balloon angioplasty.