Giant idiopathic renal arteriovenous fistula managed by coils and amplatzer device: Case report and literature review

Abstract

An idiopathic renal arteriovenous (AV) fistula is a rare malformation of the kidney that may present insidiously with heart failure or hematuria. The treatment may be challenging due to large fistula size that may limit endovascular management. The authors report a case of an 85-year-old Caucasian woman who presented with acute heart failure and was found to have a right renal AV fistula. Since she had no prior history of renal intervention or trauma, a diagnosis of idiopathic renal AV fistula was made. She was managed by endoluminal occlusion using multiple stainless steel coils and Amplatzer vascular plug II device. The follow-up computed tomography showed complete occlusion of the fistula. This report highlights the late presentation of this rare disease and presents the utility of the combination of coils and Amplatzer device for management of a large fistula. It also reiterates that even if large, these fistulas can be managed by endovascular occlusion.

Idiopathic renal arteriovenous fistula, a rare cause of severe hematuria: Case report

“…By a similar mechanism, the origin of these fistulas has also been associated with the existence of fibromuscular dysplasia renal arterial. 1 Different studies support that tobacco causes especially abdominal aneurysms and smaller amounts in other parts of the body. 1 , 3 …”

“… 1 Different studies support that tobacco causes especially abdominal aneurysms and smaller amounts in other parts of the body. 1 , 3 …”

“…Despite the high success rate of embolization, only 40% have a cure, 28% partially remit; complications have been reported in 52% of cases, such as: renal loss, tissue necrosis, venous thrombosis, pulmonary embolism, tachycardia, fever and recanalization. 1 , 2 …”

“…It is classified according to its cellular characteristics (hemangiomas or vascular malformations), according to vascular flow (high or low flow), according to arterial, venous, arteriovenous, lymphatic or combined predominance and according to its clinical behavior. 1 , 2 Renal arteriovenous fistulas can be of congenital origin (22–25%), idiopathic (3–5%) or acquired (70–75%). 2 , 3 High-flow vascular malformations (congenital) are called cirsoid aneurysms when they acquire a nest disposition.…”

“… 2 Acquired aneurysms are more frequent and may be secondary to renal traumas, tumors or iatrogenic causes such as: renal biopsy, percutaneous renal surgery, percutaneous nephrostomy, open surgery and extracorporeal shock wave lithotripsy. 1 , 2 , 4…”