Percutaneous intervention for giant renal extrarenal aneurysm and arteriovenous fistula

Abstract

Arteriovenous fistula is a high-flow vascular malformation characterized by a direct connection between an artery and a vein without the presence of a nidus (a network of arterial and venous channels). Renal artery aneurysm concomitant with a renal arteriovenous fistula (RAVF) is extremely rare. We report the case of a 45-year-old woman with a giant renal artery aneurysm combined with RAVF who presented with gross hematuria. The patient was successfully treated by embolization of a giant extrarenal aneurism and RAVF using coils and a plug device. RAVF can lead to harmful complications, and treatment is necessary upon diagnosis. Endovascular embolization is a feasible, efficient, and safe method able to retain maximal normal renal function.

Keywords: Hematuria; Renal arteriovenous fistula; Renal artery aneurysm.

Fig. 1

Color Doppler longitudinal plane showed a high-velocity, turbulent aneurysm in the left inferior renal pole.

Fig. 2

Abdominal CT images (A) axial plane and (B) coronal plane showed a giant left renal artery aneurysm (asterisk).

Fig. 3

Abdominal 3-dimensional computed tomography scan. A: Posterior view showing the left interlobar renal artery branch (arrow). B: Anterior view, showing the left renal vein (arrow). (*: Left interlobar renal artery branch, **: Left interlobar renal vein branch).

Fig. 4

Selective angiogram of the left renal artery. Arrow: Left interlobar renal artery branch; dashed line: renal artery aneurysm.

Fig. 5

Selective angiogram of the left renal artery after the procedure. Arrow: Two Ruby Coils and one vascular plug II were inserted.