Date:
Patient:
Reason for Visit:
Follow-up for renal artery aneurysm (RAA)
Assessment of aneurysm size and stability
Evaluation for symptoms or complications (e.g., hypertension, renal insufficiency)
Management plan discussion
History:
Presenting Illness:
Date of initial RAA diagnosis
Size and location of RAA on initial imaging
Presence of associated conditions (e.g., atherosclerosis, fibromuscular dysplasia)
Current symptoms (e.g., flank pain, hematuria, hypertension)
Past Medical History (PMH):
Underlying medical conditions (e.g., hypertension, coronary artery disease)
Prior surgeries or interventions for RAA
Family History:
History of aneurysms in first-degree relatives
Social History:
Smoking history (major risk factor)
Physical Exam:
General: Assess for signs of abdominal pain, tenderness, or pulsatile masses.
Blood Pressure: Evaluate for hypertension (potential cause and complication).
Abdominal: Auscultate for bruits over the abdomen or flanks (may suggest turbulent blood flow in a large aneurysm).
Diagnostic Tests (may be ordered depending on clinical presentation):
Imaging Studies:
Renal artery Doppler ultrasound: Non-invasive, readily available, monitors aneurysm size and blood flow characteristics.
Renal angiography: Definitive imaging for evaluating RAA location, size, and involvement of renal artery branches. May be performed with CT scan (CTA) or magnetic resonance angiography (MRA).
Assessment:
Aneurysm size and growth rate: Compare to previous imaging studies to assess stability or progression.
Presence of symptoms: Evaluate for abdominal pain, hematuria, or worsening hypertension.
Risk of complications: Based on aneurysm size, location, and presence of symptoms. Potential complications include rupture, thrombosis (blood clot formation), and renal artery stenosis (narrowing).
Management plan:
Active surveillance: For small, asymptomatic RAA with close monitoring with imaging.
Endovascular repair (EVAR): Minimally invasive procedure using a stent graft to exclude the aneurysm from blood flow (for suitable aneurysms).
Open surgical repair: Removal and replacement of the affected portion of the renal artery with a graft (for large, symptomatic, or complex aneurysms).
Plan:
Management approach based on assessment:
Active surveillance with serial imaging: Schedule regular ultrasound or CTA/MRA to monitor aneurysm size.
Referral to a vascular surgeon: For discussion of intervention options (EVAR or open surgery) if indicated.
Medical management:
Address risk factors: Smoking cessation, medications for blood pressure control, and cholesterol management.
Consider medications to prevent blood clots (antiplatelet therapy) in some cases.
Patient education: Provide information about RAA, risk factors, potential complications, and treatment options.
Discuss the importance of regular follow-up, reporting any new symptoms promptly, and maintaining a healthy lifestyle.
Follow-up:
Schedule for follow-up appointments based on risk:
More frequent visits for patients with larger aneurysms, symptoms, or on active surveillance.
Less frequent visits for patients with small, stable aneurysms and no symptoms.
Repeat imaging studies at defined intervals to monitor aneurysm size and stability.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of renal artery aneurysm