Carcinoma of Both Kidneys Presenting as Arteriovenous Fistulae

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review

“…Interestingly, right heart catheterization revealed the presence of an arteriovenous fistula in some cases (14). The post-treatment follow-up data showed a decrease in cardiac output in all reported cases (5,9,13,16,28).…”

“…In the majority of published cases, the tumors causing heart failure due to an arteriovenous fistula in the systemic circulation were renal cancers (22 out of 30 cases) ( 2 - 4 , 6 , 7 , 9 , 11 - 19 , 21 , 22 , 24 , 25 , 28 , 29 ), including mostly renal cell carcinoma. Cases of clear cell carcinoma, which is the most common type of renal cell carcinoma, frequently involve a mutated von Hippel-Lindau tumor suppressor gene.…”

“…However, the bruit was not detected in some of the previous cases ( 11 , 13 , 19 , 25 ), and the absence of bruit is not always indicative of the absence of an arteriovenous fistula. Systolic hypertension, which also results from an arteriovenous fistula because of an increase in cardiac output ( 37 ), was observed in most cases ( 2 - 9 , 11 - 15 , 17 , 22 , 24 , 28 , 30 ).…”

“…Preoperative right heart catheterization was performed in 12 cases ( 5 , 8 , 9 , 12 - 14 , 16 , 17 , 23 , 27 , 28 ), and follow-up right heart catheterization was performed in 6 cases after treatment ( 5 , 9 , 13 , 16 , 28 ). The pre-treatment cardiac output was 8.14-15.2 L/min ( 5 , 9 , 13 , 17 , 27 , 28 ), and an increase in the oxygen saturation level was noted in 8 cases ( 5 , 8 , 9 , 12 , 14 , 27 , 28 ). Interestingly, right heart catheterization revealed the presence of an arteriovenous fistula in some cases ( 14 ).…”

“…In two cases, embolization of the arteriovenous fistula was performed, which resulted in the improvement of heart failure ( 16 , 20 ). In one case, radiation therapy brought temporary relief of heart failure symptoms ( 9 ). When treating malignant tumor, direct therapies, including resection, embolization, or radiation, are usually considered, and these can also be used to treat heart failure.…”