{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:09:40Z","timestamp":1790244580361,"version":"4.1.0"},"reference-count":13,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Renal artery aneurysms (RAAs) are uncommon visceral arterial lesions whose management depends on symptoms, patient-specific rupture risk, and arterial anatomy. Markedly high origin renovisceral arteries may further complicate endovascular access and reconstruction. This report describes the management of a symptomatic RAA in a young woman with multifocal aneurysmal disease and unusual renovisceral arterial origins at the 11th and 12th thoracic vertebral levels (T11\u2013T12). Case presentation: A 35-year-old woman presented with intermittent right loin pain. Computed tomography angiography demonstrated multiple right renal artery aneurysms, the largest measuring 1.7 cm, together with a 0.6-cm left renal artery aneurysm and a 0.67-cm superior mesenteric artery aneurysmal dilatation. The celiac trunk, superior mesenteric artery, and both renal arteries originated unusually high at the T11\u2013T12 level. An initial trial of right renal artery stenting through right brachial access was technically difficult. Selective angiography after difficult cannulation demonstrated contrast extravasation from a minute right renal artery perforation. The patient remained hemodynamically stable; heparin was reversed with protamine, and repeat angiography 5 min later demonstrated complete sealing without further extravasation. The procedure was therefore aborted with close inpatient observation. Definitive treatment was achieved by ligation of the right renal artery aneurysmal segment and a retrocaval aorta-to-right renal artery bypass using a reversed great saphenous vein graft. At six months, the graft remained patent with preserved renal perfusion and no recurrence of the presenting symptom. Conclusions: This case demonstrates how extreme renovisceral anatomical variation, multifocal aneurysmal disease, and adverse arterial characteristics can limit the feasibility of endovascular treatment. In selected patients in whom secure endovascular access or renal branch preservation cannot be achieved, open reconstruction remains an effective renal-preserving option. Long-term surveillance is important because of the remaining untreated aneurysmal lesions and the limited duration of follow-up in this report.<\/jats:p>","DOI":"10.3390\/jcm15197408","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:07:54Z","timestamp":1790240874000},"page":"7408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High-Origin Visceral and Renal Arteries with a Symptomatic Right Renal Artery Aneurysm: A Case Report and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0468-9215","authenticated-orcid":false,"given":"Abdulaziz","family":"Althunayan","sequence":"first","affiliation":[{"name":"Division of Urology, Department of Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8731-1008","authenticated-orcid":false,"given":"Othman","family":"Alabdullah","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1316-6109","authenticated-orcid":false,"given":"Ghadah","family":"Alarify","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9250-7010","authenticated-orcid":false,"given":"Joud","family":"Aldar","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6913-8612","authenticated-orcid":false,"given":"Mohammed","family":"Almasabi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaisor","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4528-1662","authenticated-orcid":false,"given":"Sultan","family":"AlSheikh","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1868-0265","authenticated-orcid":false,"given":"Abdulmajeed","family":"Altoijry","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2020.01.039","article-title":"The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms","volume":"72","author":"Chaer","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1111\/ans.18628","article-title":"Outcomes of endovascular, open surgical and autotransplantation techniques for renal artery aneurysm repair: A systematic review and meta-analysis","volume":"93","author":"Choksi","year":"2023","journal-title":"ANZ J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.23736\/S0021-9509.23.12809-6","article-title":"Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: A joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)","volume":"65","author":"Pratesi","year":"2024","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ejvs.2025.06.010","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins","volume":"70","author":"Koelemay","year":"2025","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1148\/rg.2021200162","article-title":"Renal Arteries Revisited: Anatomy, Pathologic Entities, and Implications for Endovascular Management","volume":"41","author":"White","year":"2021","journal-title":"Radiographics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s12565-020-00571-x","article-title":"Distance measurements and origin levels of the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery by multiple-detector computed tomography angiography","volume":"96","author":"Ekingen","year":"2021","journal-title":"Anat. Sci. Int."},{"key":"ref_7","first-page":"69","article-title":"Thoracic origin of the right renal artery: An incidental finding","volume":"28","author":"Sousa","year":"2021","journal-title":"Port. J. Card. Thorac. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s00270-023-03620-w","article-title":"CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms","volume":"47","author":"Rossi","year":"2024","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.jvir.2024.04.004","article-title":"A Qualitative Systematic Review of Endovascular Management of Renal Artery Aneurysms","volume":"35","author":"Sheahan","year":"2024","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Dubosq-Lebaz, M., Benzimra, C., Jouffroy, M., Roisin, S., Pruvot, L., Hostalrich, A., Fabre, D., Kaladji, A., Sobocinski, J., and Azzaoui, R. (2026). When Anatomy Matters Most: A Multicentre Evaluation of Strategies for Renal Artery Aneurysm Repair. Eur. J. Vasc. Endovasc. Surg., advance online publication.","DOI":"10.1016\/j.ejvs.2026.06.057"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.jvs.2022.11.010","article-title":"Natural history of renal artery aneurysms","volume":"77","author":"Zhang","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/1754-9485.13869","article-title":"Natural History of True Renal Artery Aneurysms: A Multi-Centre Retrospective Cohort Study and Proposed Algorithm for Follow-Up","volume":"69","author":"Briody","year":"2025","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_13","first-page":"140","article-title":"Popliteal artery aneurysmal dilatation by intimomedial mucoid degeneration causing emergency limb ischemia: A case report and literature review","volume":"20","author":"Iqbal","year":"2024","journal-title":"Signa Vitae"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7408\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:35:36Z","timestamp":1790242536000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":13,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197408"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197408","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}