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

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.

An arteriovenous fistula in the right kidney as a cause of right ventricular heart failure

“…An arteriovenous fistula should be considered as a cause of high-output right ventricular failure, not only in patients undergoing hemodialysis [1] but also in those with an unclear cause of right ventricular failure [2], especially when echocardiography reveals high TRPG resulting from volume overload accompanied by prolonged PA-AcT due to a low transpulmonary pressure gradient. Endovascular closure of the arteriovenous fistula resolved the heart failure in this patient [3,4]. Moreover, ovarian cancer serum markers, such as CA-125, can be elevated in the course of heart failure, which should be taken into account when considering a patient's qualification for surgery [5].…”

Endovascular Treatment of a Giant Renal Artery Aneurysm with High-Flow Renal Arteriovenous Malformation

“…Although their true incidence and natural history remain elusive, the prevalence of RAAs in the general population is approximately 0.09% [ 1 ]. Renal artery arteriovenous malformations (AVMs) with the high flow can be idiopathic, congenital, or acquired and are also rare, with an estimated incidence of less than 0.04% [ 2 , 3 ]. The co-existence of RAA with AVM is an extremely rare condition that complicates the natural history of the disease, the clinical presentation, and certainly the operational treatment options [ 4 ].…”

Percutaneous intervention for giant renal extrarenal aneurysm and arteriovenous fistula

“…Arteriovenous malformations can be classified as acquired, idiopathic, or congenital. Recently, percutaneous intervention embolization has become the first-line treatment option for arteriovenous malformations [2] . Endovascular treatment is a less invasive alternative to traditional open surgery [ 3 , 4 ].…”