Endovascular Treatment of Renal Arteriovenous Fistula with N-Butyl Cyanoacrylate (NBCA)

Abstract

SummaryBackgroundRenal arteriovenous malformation (RAVM) is a rare disease. The causes of pathological connections between renal arteries may be congenital or iatrogenic – mainly as a consequence of a biopsy or due to renal carcinomas and postinflammatory changes. Computed tomography, ultrasound Doppler and angiography are the main diagnostic tools used for the detection of RAVMs.Case ReportThe aim of this study is to present a case of endovascular treatment of RAVM with a mixture of NBCA and lipiodol. A 29-year-old woman was suffering from drug-resistant hypertension secondary to RAVM. The malformation was embolized using NBCA mixed with lipiodol. The postoperative course was uneventful. A follow-up angio-CT, performed 3 months and one year after the procedure, showed a complete occlusion of the RAVM.ConclusionsNBCA can be used alone to embolize RAVMs. Procedures involving a combination of NBCA and lipiodol are difficult and should be performed by experienced specialists.

Fístula arteriovenosa renal pós-biópsia renal: relato de caso e revisão de literatura

“…These are rare, with incidence rates of 3 to 5% in native kidneys and 10 to 16% in transplanted kidneys, but AVFs can be avoided or their incidence reduced to less than 0.1% if biopsy is conducted with real-time ultrasound guidance and automatic needles. 1,16,17 The procedure is considered a success if, in addition to acquiring sufficient material for diagnostic biopsy, it causes less adverse outcomes for the patient. 18 An arteriovenous fistula is an anomalous communications between the arterial and venous systems.…”

“…Acquired AVFs are caused by trauma, inflammation, surgery, tumors, atherosclerosis, or percutaneous biopsy and account for 70 to 80% of arteriovenous abnormalities. 1,12,17 Of these, the most common are AVFs associated with percutaneous renal biopsy, those caused by traumas, and those secondary to percutaneous renal surgery. 13 An idiopathic AVF is one that is acquired at some point during life, but has no definite etiologic factor.…”

“…19,20 The objective of treatment of fistulae and renal arteriovenous malformations is to eradicate the symptoms and hemodynamic effects (arterial hypertension and heart failure), with maximum preservation of functioning renal parenchyma. 12,17,21 Less aggressive treatment options include blood transfusions. Invasive options that may be necessary in refractory cases and those with major hematuria or hemodynamic instability 6 include cystoscopy, angiography with subsequent embolization with gel-foam or coils (with a success rate of around 85% in patients with acquired fistulae), and surgical nephrectomy.…”

“…15,19,23 It is a widely adopted treatment option that can be used as definitive treatment or in an attempt to reduce fistula throughput, and is a less invasive surgical procedure. 12,17,21 The many different embolization agents employed include steel coils, as used in the case described here, balloons, autologous blood clots, absorbable gelatin foam, cyanoacrylate, plastic polymers, and absolute alcohol. 24 Controlled-release coils offer certain advantages in relation to other methods.…”

Clinical efficacy of absolute ethanol combined with n‑butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children

“…NBCA is an acrylic adhesive. In the blood, it rapidly polymerizes with free hydroxide in plasma and causes blood clots (22). As the acrylic adhesive is in liquid form, it can be evenly dispersed throughout the lesions and can promote embolic effects (23).…”