Contemporary Management of Giant Renal and Visceral Arteriovenous Fistulae

Abstract

Endovascular treatment of giant renal/visceral AVFs is challenging but feasible and safe, with good organ preservation. Endovascular techniques have replaced open surgical repair as a first-line treatment for these challenging lesions.

Transcatheter Amplatzer vascular plug-embolization of a giant postnephrectomy arteriovenous fistula combined with an aneurysm of the renal pedicle by through-and-through, arteriovenous access

“…As in the present case, an aneurysm of the renal pedicle is sometimes associated with the AVF [6], [7], [8], but is not a sine qua non condition.…”

“…As in our case, development, or at least, diagnosis of renal arteriovenous fistulas is occasionally achieved late, some cases have been reported up to 40 years after nephrectomy (mean 14.5 years) [8]. …”

“…According to similar case reports, patients concerned often present with flank pain, easy fatigability with exercise, and dyspnea due to a high shunt-volume [8]. …”

“…Giant AVFs can be responsible for increased cardiac output / cardiac index and decreased periphereal resistance which leads to diastolic overload and finally to heart failure [9]. At the time of diagnosis, 90% of patients have a bruit which can be heard over the corresponding flank [8], [10], 80% have cardiomegaly, 50% have signs of heart failure and 40% experience pain [8], [11]. …”

“…Endovascular techniques have replaced open surgical repair as a first-line treatment for these challenging lesions [8]. Transcatheter embolization of large, high-flow arteriovenous fistulas carries a significant risk for migration of embolic material through the fistula and into the venous outflow and subsequently into the pulmonary arteries [12].…”