Abstract:BackgroundArteriovenous malformations (AVMs) are communications between an artery and a vein outside the capillary level. This pathologic communication may be either a fistula, a simple communication between a single artery and a dilated vein, or a more complex communication, a nidus of tortuous channels between one or more arteries/arterioles and one or more draining veins. The latter type of lesion is most frequently seen in the extremities; in the kidney they tend to appear more rarely. The most common clin… Show more
“…CT scans should therefore be performed with a thin section using a collimation of at least 1 mm and a reconstruction interval of 0.5-1 mm. A multiphasic scan, at least biphasic, is required to detect renal AV shunts, venous thrombosis, or other potential causes of symptoms (24). At least 32 detectors for multidetector row CT is preferable for the detection of small AV shunts because appropriate scan timing when using a fast-scan technique is an important factor for evaluating high-flow shunts.…”
Section: Imaging Features Of Renal Av Shuntsmentioning
Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.
“…CT scans should therefore be performed with a thin section using a collimation of at least 1 mm and a reconstruction interval of 0.5-1 mm. A multiphasic scan, at least biphasic, is required to detect renal AV shunts, venous thrombosis, or other potential causes of symptoms (24). At least 32 detectors for multidetector row CT is preferable for the detection of small AV shunts because appropriate scan timing when using a fast-scan technique is an important factor for evaluating high-flow shunts.…”
Section: Imaging Features Of Renal Av Shuntsmentioning
Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.
“…Renal AVF is a pathological process that involves renal arteries and veins including congenital and acquired AVFs. 3,5 Acquired AVF is more common than congenital AVF and is usually caused by surgery, percutaneous biopsy, penetrating trauma, inflammation, or malignancy. Injury-related renal AVF is an acquired form of vascular abnormalities.…”
Renal arteriovenous fistulas are rare complications of kidney injury that are usually caused by penetrating or blunt abdominal trauma, percutaneous or open biopsy, or surgery. We report a case of renal arteriovenous fistula after blunt abdominal trauma of a male patient who had traffic accidents. Computed tomography images show arteriovenous fistula lesion mimicking the tumor of the renal pelvis. Through this case, we present how to identify and avoid being confused in diagnosis as well as introduce its clinical manifestations, imaging, and treatment.
“…The CT hallmark of AVF includes tortuous arteries and early or simultaneous opacification of one or more intra-parenchymal arteries and veins during the corticomedullary phase (Fig. 8 ) [ 55 , 56 ]. Fig.…”
Section: Haemorrhagic and Vascular Complicationsmentioning
confidence: 99%
“…Selective angiography evaluates the lesion dynamically and allows planning for trans-arterial embolisation (TAE) and super-selective catheterisation [ 56 ]…”
Section: Haemorrhagic and Vascular Complicationsmentioning
confidence: 99%
“…In patients with post-surgical IRVI, TAE using coils or other embolisation agents proved to be safe and effective treatment with a low rate of complications, rapid recovery and short hospital stay, and excellent (nearly 100 %) technical and clinical success rates, respectively corresponding to complete angiographic exclusion of bleeding and haemodynamic stabilisation without the need for blood transfusion. Super-selective embolisation, carried out as distally as possible is recommended to minimise parenchymal loss and avoid long-term impairment of renal function [ 32 , 55 , 56 ]. Fig.…”
Section: Haemorrhagic and Vascular Complicationsmentioning
PurposeLaparoscopic nephron-sparing surgery (L-NSS) is increasingly performed to treat localised renal lesions. However, the associated morbidity is non-negligible, with a rate of major complications approaching 10 %.Methods and ResultsThis paper provides an overview of indications, surgical techniques and results of L-NSS; explains the incidence, risk factors and manifestations of postoperative complications; discusses the preferred multidetector computed tomography (CT) acquisition techniques; illustrates the appearance of normal postoperative images following L-NSS; and reviews, with example images, the most common and unusual iatrogenic complications. These include haematuria, haemorrhage, vascular injuries, infections and urinary leaks. Most emphasis is placed on CT, which provides rapid, reliable triage and follow-up of iatrogenic complications after L-NSS, identifying occurrences that require transarterial embolisation or repeated surgery.ConclusionsMultidetector CT allows precise assessment of the surgical resection site; detection of pneumoperitoneum and subcutaneous emphysema; quantification of retroperitoneal blood; and identification of active bleeding, pseudoaneurysms, arterio-venous fistulas, abscess collections and extravasated urine.Teaching Points• Laparoscopic nephron-sparing surgery (NSS) is increasingly performed to treat renal lesions.• Radiologists are increasingly requested to investigate suspected post-surgical NSS complications.• Post-NSS complications include haemorrhage, haematuria, vascular injuries, infections and urinary leaks.• Multidetector CT allows choice between conservative treatment, transarterial embolisation or surgery.
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