Idiopathic renal arteriovenous fistula demonstrating a huge aneurysm with a high risk of rupture: Report of a case

Abstract

This paper reports a case of an idiopathic renal arteriovenous fistula demonstrating a huge guitar-shaped aneurysm, which required a total nephrectomy. Although the patient insisted on having been asymptomatic, echocardiography and cardiac catheterization clearly revealed that the influence on hemodynamics was unexpectedly significant. Interestingly, the aneurysm was also considered to have a high risk of rupture, which was preoperatively suggested by an aneurysm wall projection discernible on both computerized tomograms and angiograms, and this suspicion was also convincingly supported by the perioperative and histopathological findings.

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

“…Idiopathic fistulas occur in the absence of predisposing factors, are usually seen in middle aged patients and often present with cardiovascular symptoms like hypertension or congestive heart failure. They are hypothesized to be caused by erosion of an intraparenchymal renal arterial branch aneurysm into a vein[3,5]. Our case also shows a large renal artery aneurysm supporting this hypothesis.…”

“…Endoluminal occlusion is usually the management of choice in renal AV fistulae since it occludes the shunt while preserving the renal function[11]. Large shunt size and possibility of migration of embolizing material may limit endovascular management, warranting surgical management[3,4,12]. Traditionally stainless steel coils, gel foam and covered wall stents have been used as endovascular agents for the management of these cases[13].…”

“…The idiopathic AV fistula is usually large and has high flow; features that may limit the endovascular management due to the possibility of incomplete occlusion and migration of embolizing material[2]. Some reports in the literature have favored nephrectomy due to the large size of shunt and multiplicity of the shunt vessels[3,4]. We report a case of an elderly female presenting with heart failure due to idiopathic renal AV fistula that was successfully treated by embolization of renal artery aneurysm by multiple coils and occlusion of the distal limb of renal artery by Amplatzer vascular plug (AVP) II device.…”

A giant idiopathic renal arteriovenous fistula associated with high‐output heart failure

“…TAE is currently performed as the first‐line treatment for renal AV fistulas, except in cases of high‐flow aneurismal fistulas, because recognizing details of the hemodynamic anatomy is difficult and a risk of pulmonary embolism exists due to the migration of the embolic agent to the draining vein. To our knowledge, only one prior report has described a fistula over 10 cm; both it and the present case were treated by nephrectomy 4 …”

Postnephrectomy Renal Arteriovenous Fistula

“…Although the risk of rupture is thought to be very low, a number of reports have described spontaneous rupture of such aneurysmal lesions. 10 The treatment of renal AVFs depends on size and etiology. Small iatrogenic fistulas often close spontaneously.…”