Ex vivo renal artery reconstruction is an extensive procedure used to treat complex aneurysms of the artery that supplies your kidney. It involves removing your kidney, repairing the artery, and transplanting your kidney back.

Ex vivo renal artery reconstruction and autotransplantation, often shortened to ex vivo renal artery reconstruction, is a surgical technique for treating a renal artery aneurysm. A renal artery aneurysm is a weakened and expanded section of the blood vessel that supplies your kidney.

“Ex vivo” means outside of your body. “Autotransplantation” means to transplant your own tissue.

The procedure involves temporarily removing your kidney, repairing the artery, and then retransplanting your kidney. It’s usually reserved for complex aneurysms that involve multiple branches of your renal artery or the part of your renal artery closest to your kidney.

Read on to learn more about this procedure, including when you might need it, what to expect during the procedure, and potential complications.

Ex vivo renal artery reconstruction is used to treat renal artery aneurysms. It’s an elective surgery to prevent the aneurysm from rupturing.

Renal artery aneurysms occur in 0.1–2.5% of people in the larger population. They are usually diagnosed during imaging for unrelated reasons. A rupture of the renal artery is a medical emergency. It has a high risk of death.

An ex vivo renal artery reconstruction is used to treat complex aneurysms that involve multiple branches of your renal artery or the parts of your artery close to your kidney. For simpler procedures, doctors may perform the repair using techniques that don’t require the removal of your kidney.

Current evidence supports that renal artery aneurysms should be repaired if they exceed 3 centimeters (1.2 inches) in diameter or if they occur in people with:

In a 2022 review, researchers reported complications in 6.9% of 199 people who received ex vivo renal artery reconstruction.

The most common complications were:

  • urinary tract infection (2.0%)
  • wound infection (1.3%)
  • reduced kidney function (0.6%)
  • thrombus, or a graft blood clot (0.6%)
  • kidney hypoperfusion, which is a lack of blood flow to the kidney (0.6%)
  • bruising (0.6%)
  • lymphocele, which is a collection of lymph fluid (0.6%)
  • pseudoaneurysm, which is an injury of the blood vessel wall (0.6%)
  • occlusion, which is an artery blockage (0.6%)

Ex vivo renal artery reconstruction can be highly effective at treating aneurysms in your renal artery, especially when the surgery may be too difficult to perform using other surgical techniques.

It’s often the surgery of choice when the kidney needs to be disconnected from its blood supply for more than 30–60 minutes.

According to a 2019 case report and review, some studies have found that up to 100% of people had blood flow through their renal artery at a 1-year follow-up. Other studies report mortality rates from 0–9.6%.

Here’s a general idea of what to expect before, during, and after an ex vivo renal artery reconstruction.

Before the procedure

Before your procedure, your care team orders tests, like a chest X-ray or blood tests, to measure your overall health. You may be told to stop taking certain medications, such as blood thinners.

Before your procedure, doctors administer general anesthetics through an intravenous (IV) line to put you to sleep.

During the procedure

Doctors can perform the surgery through a large incision or with a small incision using a thin tube called a laparoscope.

Here’s a general idea of what to expect if your surgeon performs the surgery through a large incision:

  1. Your surgeon makes an incision in your lower back to access your kidney.
  2. They remove your kidney and put it on ice.
  3. Your surgeon repairs the damaged section of your artery and may remove dead tissue.
  4. They reattach your kidney and close your surgical wounds with stitches or surgical clips.

After the procedure

When you wake up in the recovery room, you’ll be connected to a urinary catheter, IV, and other devices to measure your vitals. You can drink fluids shortly after waking and may be able to eat a light meal several hours later.

Your care team will likely give you blood-thinning medications to help avoid the development of blood clots.

You typically won’t be able to eat for at least 6 hours and drink at least 2 hours before your procedure. Follow your doctor’s instructions, as this time is sometimes longer.

You won’t be able to drive after your procedure, so it’s important to prepare a ride home in advance.

Doctors often recommend quitting smoking before procedures that require general anesthesia to reduce your chances of complications.

Most people can leave the hospital about a week after a kidney transplant. You should be able to return to work and your usual activities within a few months if serious complications don’t develop.

To give you a rough idea of the cost, the nonprofit FAIR Health estimates that more than 80% of procedures to repair a complex aneurysm of a neck artery in Boston are less than $22,142, with anesthesia potentially costing another $6,669.

The nonprofit estimates that 80% of procedures to remove a kidney and transplant a donor’s kidney cost less than $16,789 in Boston, with anesthesia potentially costing another $4,713.

Many insurance programs, including Medicare, cover at least part of the cost if it’s a medically necessary procedure, but it’s essential to check your coverage in advance.

Ex vivo renal artery reconstruction is usually reserved for complex aneurysms. For simpler procedures, your doctor may use other surgical techniques that don’t require removing your kidney.

Both open and endovascular techniques can be used to repair a renal artery aneurysm. Open surgery involves repairing your renal artery through a large incision. Endovascular surgery involves repairing it with special tools that are inserted into your blood vessels.

Undergoing an ex vivo renal artery reconstruction can help prevent the rupture of a renal artery aneurysm, but it does come with some risks of complications.

Your doctor can advise whether they think your aneurysm needs treatment and what the best treatment option may be.