Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Feb 1;14(2):e236358.
doi: 10.1136/bcr-2020-236358.

Endovascular management of a patient with massive renal arteriovenous fistula: challenges and tricks

Karthikumar Balasubramanian  1 , Shyamkumar N Keshava  2 , Audrin Lenin  3 , Rajiv Mukha  4
Affiliations
Review

Endovascular management of a patient with massive renal arteriovenous fistula: challenges and tricks

Karthikumar Balasubramanian et al. BMJ Case Rep. .

Abstract

We describe the endovascular management of a patient with a massive renal arteriovenous fistula and a huge venous aneurysmal sac, who presented with features of cardiac failure and fever. The challenges faced and the outcomes are discussed with relevant literature review.

Keywords: renal intervention; renal system.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
DSA and schematic diagram. (A) Large right renal arteriovenous fistula (AVF) through a dilated and elongated renal artery with aneurysmal dilatation of the venous end. (B) Right kidney rotated anteriorly to depict the coarse segments of abnormal renal artery (two vertical and one horizontal segments). Arrow indicates the posterior branch supplying normal renal parenchyma. DSA, Digital subtraction angiography.
Figure 2
Figure 2
DSA. (A) Post embolisation angiography showed flow reduction. (B) Demonstration of normal renal artery branch supplying the parenchyma posteriorly. DSA, Digital subtraction angiography.
Figure 3
Figure 3
Digital subtraction angiography (DSA) and contrast enhanced computed tomography (CECT) abdomen. (A) Dislodged Amplatzer vascular plug into the venous sac and impinged over the posterior wall. (B) Same in CT with contrast filled venous sac.
Figure 4
Figure 4
Digital subtraction angiography (DSA) and schematic diagram. (A) Complete occlusion of vertical segment of renal artery and no flow to fistula an venous sac with normally opacified parenchymal branch. (B) Schematic diagram depicting the packing of Amplatzer vascular plugs and coils in vertical segment of renal artery. Arrow indicates location of old dislodged plug.
Figure 5
Figure 5
Immediate postprocedure MRI depicting the thrombosed venous sac.
Figure 6
Figure 6
Chest radiograph on admission and after 6 months. (A) Chest radiograph before the procedure with cardiothoracic ratio (CTR) 0.7. (B) Postprocedure chest radiograph after 5 months post embolisation.
See this image and copyright information in PMC

References

    1. Sakoda T, Nishimukai A, Tsujino T, et al. . Two giant renal aneurysms and renal arteriovenous fistula associated with cardiac insufficiency and a sustained elevation of atrial natriuretic peptide and brain natriuretic peptide. Am J Med Sci 2007;333:300–4. 10.1097/MAJ.0b013e318053e0fd - DOI - PubMed
    1. Cura M, Elmerhi F, Suri R, et al. . Vascular malformations and arteriovenous fistulas of the kidney. Acta Radiol 2010;51:144–9. 10.3109/02841850903463646 - DOI - PubMed
    1. Cho SK, Do YS, Shin SW, et al. . Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther 2006;13:527–38. 10.1583/05-1769.1 - DOI - PubMed
    1. Okamoto Y, Sugimoto T, Yamamoto K, et al. . Heart failure caused by renal arteriovenous fistula with giant renal artery aneurysms. Vasc Endovascular Surg 2014;48:434–7. 10.1177/1538574414543274 - DOI - PubMed
    1. Hatzidakis A, Rossi M, Mamoulakis C, et al. . Management of renal arteriovenous malformations: a pictorial review. Insights Imaging 2014;5:523–30. 10.1007/s13244-014-0342-4 - DOI - PMC - PubMed

MeSH terms