Hypertension artérielle révélatrice d'une fibrodysplasie rénale anévrismale

A 20-year-old woman consulted for severe hypertension which revealed aneurismal stenosing fibrodysplasia of the renal arteries. The diagnosis was established by duplex Doppler which visualized tight stenosis of the distal portion of the right renal artery and the proximal portion of the left, associated with aneurismal lesions downstream from the strictures (1.8 cm on the right and 1.3 cm on the left). The lesions were highly suggestive of fibrodysplasia and were confirmed by magnetic resonance angiography. Endoluminal revascularization was undertaken because of the severe hypertension and the presence of arterial lesions. Revascularization was unsuccessful and severe hypertension persisted. Surgery was performed in two stages. The first procedure consisted in resection of the left aneurismal lesion with aortorenal internal saphene bypass. Secondarily, exclusion of the right aneurysm was performed with cure of the stricture by extracorporal renal surgery with anastomosis of the renal artery to the aorta and the renal vein to the vena cava. Clinical outcome was favorable. Angioscan and duplex Doppler controls at three and six months confirmed the anatomic success of the revascularization. Aneurysm of the renal artery, like renal artery stenotic dysplasia, is a rare but probably underestimated condition due to insufficient screening. This diagnosis should be entertained in hypertensive young women. There is risk of rupture of the aneurysm. Aneurysmal lesions can be associated with renal artery stenosis which usually involves a short segment of the artery, as in our case. Renal aneurysms should be treated when one of the following elements is present: aneurysm measuring more than 20 mm, progressing aneurysm, dissection, discovery in a patient with a renal risk (single kidney, renal insufficiency), desire for pregnancy, severe hypertension recently discovered in a young subject associated with dysplastic stenosis, isolated aneurysm associated with recent severe hypertension, as reported here. (J Mal Vasc 2005; 30: 296-300)