Successful embolization of a renal arteriovenous fistula; a feared kidney biopsy complication

Abstract

The authors report a case of a 57-year-old woman who was successfully treated with a percutaneous embolization procedure for a renal arteriovenous fistula that developed as a complication of a kidney biopsy. An acute kidney injury that failed to resolve with medical management prompted further investigation with a renal biopsy. Five hours after the kidney biopsy, the patient became hemodynamically unstable with a blood pressure of 77 of 52 mm Hg. A stat abdominal computed tomography scan without contrast discovered a large left-sided perinephric hematoma that measured up to 11.5 cm with a moderate amount of perinephric blood. An angiogram subsequently demonstrated the presence of an arteriovenous fistula at the inferior pole of the left kidney. Several 2 × 3 mm and 3 × 3 mm coils were deployed into two separate segmental branches of the inferior pole, and the post embolization angiogram confirmed resolution of the previously visualized arteriovenous fistula.

Keywords: Arteriovenous fistula; Embolization; Interventional radiology; Kidney biopsy; Nephrology.

Fig. 1

CT scan displaying the biopsy needle in the lower pole of the left kidney.

Fig. 2

Abdominal CT scan displaying a large left-sided perinephric hematoma.

Fig. 3

Renal angiogram showing abnormal enhancement at the inferior pole of the left kidney, raising suspicion for an arteriovenous fistula.

Fig. 4

Second renal angiogram confirmed rapid visualization of draining inferior renal vein (inferior arrow) and inferior vena cava (superior arrow) consistent with an arteriovenous fistula.

Fig. 5

Post embolization angiogram demonstrates resolution of the previously visualized arteriovenous fistula.