No abstract

BackgroundIn this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve.Case presentationSeventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline.ConclusionsPercutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein.

No abstract

We read with great interest the study by Van Wyk et al 1 which explores the beliefs and opinions held by final-year medical students on the impact of gender on their training and the medical profession they were about to enter. As fifth year medical students ourselves, studying at Imperial College London, UK, this was a study we could strongly relate to and as such, we were particularly impressed by some of the findings.Having just finished our Obstetrics and Gynaecology (OBG) rotation, our experiences highlighted to us the issue of how one's gender affects the training received during medical school. We agree with the findings of the study that there are obstacles to males performing intimate examinations, and even consultations, on female patients.