Embolisation of a high – flow renal arteriovenous fistula with the use of simultaneous transvenous and transarterial approach and balloon-assisted coil embolization

Abstract

Background Renal arteriovenous fistula (RAVF) is a rare vascular malformation, which can be asymptomatic or may cause hemorrhage, hypokalaemic hypertension, heart failure and hematuria. Endovascular embolization is a minimally invasive method which can preserve renal parenchyma. In our case, balloon assisted coil embolization with simultaneous transvenous and transarterial approach was used. A remodelling balloon, which is routinely used in neurovascular procedures, was chosen in order to eliminate the risk of coil migration and preserve feeding artery and renal parenchyma. Case presentation We present a case of successful balloon – assisted coil embolization of a high flow renal arteriovenous fistula in a 25-year-old male patient via simultaneous transarterial and transvenous approach with preservation of the feeding artery. Conclusion Endovascular embolisation is a safe and effective treatment of RAVFs with low risk of complications. Simultaneous transarterial and transvenous coil deployment with the use of a flow control balloon catheter can eliminate the risk of coil migration and coil protrusion into the parent artery with permanent RAVF occlusion and renal parenchyma preservation.