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

Abstract

Arteriovenous fistula (AVF) is an abnormal direct communication between an artery and the venous drainage without a capillary component. Although renal AVF is rare, detecting the disease is important to assist in management and, thus, help reverse the sequelae of the disease such as hypertension and heart failure. The clinical presentation and radiological features are important parameters that can help in the diagnosis and decision of treatment. We would like to share our successful approach to a 52-year-old female with idiopathic high-flow left renal AVF with concomitant renal artery aneurysm using a single Amplatzer vascular plug in the limit of our setting.

Amplatzer Vascular Plug in Renal Artery Embolization: Case Serial and Review of the Literature

“…Perioperative RAE has been introduced to reduce the risk of oncological spread and intraoperative bleeding, in order to facilitate surgery, thus decreasing perioperative morbidity. 8 Embolization of the renal artery represents the gold standard of acute bleeding. It is a valid support in the treatment of tumor renal mass and in the therapeutic management of hypervascularized renal tumor, but is also strongly recommended in the case of vascular malformations.…”

“…10 Other few cases presented the use of an AVP for the embolization of kidney arteriovenous fistula. 8,11,12 In particular, Perkov et al 12 used a 12 mm AVP II released in the main artery feeding straight the arteriovenous fistula of the right kidney, while Kayser et al 4 deployed a 7 mm AVP IV within the venous segment of the AVF and then they occluded the right renal artery with a 16 mm AVP II. In Perkov case, the occluded artery fed only the AVF without parenchymal contributions, meanwhile in Kayser case, they performed a sort of endovascular nephrectomy.…”