Large renal arteriovenous fistula treated by embolization: a case report

Abstract

Renal arteriovenous fistula (RAVF) is an uncommon vascular malformation of the kidney, which can be congenital, acquired or idiopathic. Although most patients are asymptomatic, RAVF can lead to hypertension, heart failure, renal insufficiency, hematuria, and progressive increase in size of renal vessels. Diagnosis is aided by radiological studies, with digital subtraction angiography as a gold standard. Besides, ultrasound with color Doppler and computed tomography angiography are noninvasive imaging techniques and can be useful for planning the treatment. A large fistula are generally treated by nephrectomy. Intervention can ameliorate the hemodynamic effects of high flow and to preserve the renal parenchymal function. Although endovascular therapy may be challenging due to the large size and high flow of fistula, this report describes a case of huge RAVF was successfully treated by embolization instead of surgery.

Fogarty-assisted transcatheter embolization of a large renal high-flow arteriovenous fistula

“…The majority of AVFs are acquired and occur as a result of renal interventions (e.g. renal biopsy, surgery), blunt or penetrating trauma, inflammation or malignancy, though congential and idiopathic AVFs exist (Duc 2021;Kato et al 2006). Indications for treatment in this patient included the progressive size increase, decrease of kidney function as well as the symptoms of arterial hypertension.…”

“…Renal arteriovenous fistulas (RAVF) are a rare, anomalous connection between the renal artery and vein, without intervening capillary network and considerable clinical impact, potentially leading to hematuria, hypertension, local thrombosis, renal failure, high output heart failure or in case of rupture, severe hemorrhage with life-threatening bleeding (Carrafiello et al 2011;Nagpal et al 2016). Classified into congenital (25%), idiopathic (3-5%), and acquired causes (70%), recent developments of percutaneous interventions have increased the incidence of acquired RAVFs considerably (Duc 2021;Kato et al 2006). Transcatheter embolization represents a potentially kidney-preserving, minimally invasive therapy option.…”

Endovascular embolization of idiopathic renal arteriovenous fistula – A case report and literature review

“…The exact etiology of both congenital and idiopathic RAVFs is still unknown and is often grouped together as spontaneous RAVFs. [3] Congenital RAVFs also known as cirsoid fistulas are thought to be present since birth and constitute about 25% of RAVFs. They are characterized by tangle of tortuous vessel with multiple intercommunications between artery and vein and their angiographic appearance is typical of congenital arteriovenous malformations in other parts of the body.…”

Trans-Arterial Embolization of High-Flow Renal Arteriovenous Fistula (AVF) with Concomitant Renal Artery Aneurysm

“…The aim of treatment is to relieve recurrent hematuria, circulatory overload, hypertension, and hemodynamic abnormalities. 4 It is also important to retain the functional nephron as much as possible. Although our patient's symptoms were not serious, there was a need for early treatment to prevent RAA rupture.…”

“…We found the use of polyvinyl alcohol, gel foam sponge, and cyanoacrylate unsuitable as they are small and pose a risk of dislodge, which can lead to pulmonary embolism. 4 In addition, the cost of using multiple steel coils is high and would increase patient's cost of treatment, thus not a viable option. As such, a vascular Amplatzer plug was chosen because of its ability to self-expandable, higher density, higher flow disturbances effect, and cost-effectiveness.…”