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Endovascular management of post traumatic giant renal arteriovenous fistula using occluder device

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Sir, Renal arteriovenous fistula (AVF) is often an acquired renal vascular abnormality, usually caused by biopsy, percutaneous nephrostomy, or trauma... Here, we report the endovascular management of a giant renal AVF using Amplatzer vascular plug (AVP)... Because there was hypertrophy of the MRA, a 20-mm AMPLATZER Plug II (St Jude Medical, Inc, St Paul, Minnesota, USA) was placed at the junction of the feeding artery and the PSA [Figure 1C]... Position was then confirmed by angiogram and the device was deployed... Renal AVF is generally secondary to processes invasive to renal parenchyma or renal vascular system (approximately 70%) such as biopsy, percutaneous nephrostomy, and trauma or may be congenital... Coil embolization is now the standard endovascular approach to the management of symptomatic AVF... However, transcatheter embolization of large, high-flow AVF always carries a significant risk for migration of embolic material into the pulmonary arteries... Its migration risk is less than those of coils... Limitations of AVP include need of a 5–9 F sheath and unsuitability of AVP for vessels that are too small or too large... This case illustrates the feasibility of the use of AVP in the treatment of renal AVF... There are no conflicts of interest.

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Computed tomography (CT) angiography axial (A) image showing gross aneurysmal dilatation of the left renal vein during arterial phase. CT volume rendered (B) confirmed image showing communication of the left renal artery with hugely dilated left renal vein suggestive of large arteriovenous fistula. The left main renal artery was occluded by an Amplatzer vascular plug II (C). The final digital subtraction angiography run (D) showing complete occlusion of the fistula
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Figure 1: Computed tomography (CT) angiography axial (A) image showing gross aneurysmal dilatation of the left renal vein during arterial phase. CT volume rendered (B) confirmed image showing communication of the left renal artery with hugely dilated left renal vein suggestive of large arteriovenous fistula. The left main renal artery was occluded by an Amplatzer vascular plug II (C). The final digital subtraction angiography run (D) showing complete occlusion of the fistula

Mentions: A 32-year-old male patient initially presented with a 6-month history of left flank pain. The pain was dull, intermittent, and non-radiating. He had a history of bullet injury 7 years back in the left flank. On physical examination, a continuous bruit was audible over the left flank. Doppler evaluation revealed a large cystic lesion at the left renal hilum with increased flow velocity and decreased arterial resistance, and mixing of arterial and venous waveform was also observed. A computed tomography angiography (CTA) was performed which revealed contrast opacification of the renal vein during the arterial phase suggesting renal AVF. A giant pseudoaneurysm (PSA) was also seen occupying the mid and lower pole of the left kidney [Figure 1A] measuring 7 cm × 6.5 cm × 6 cm. The main renal artery (MRA) was the possible feeder artery to the AVF which was seen directly opening into the PSA, suggesting an ultrashort segment of fistulous communication. Main renal vein appeared to be directly communicating with the pseudoaneurysm and was also dilated grossly with aneurismal morphology. The morphology and extension of the vascular lesion was well-demonstrated on the volume rendering technique image [Figure 1B].


Endovascular management of post traumatic giant renal arteriovenous fistula using occluder device
Computed tomography (CT) angiography axial (A) image showing gross aneurysmal dilatation of the left renal vein during arterial phase. CT volume rendered (B) confirmed image showing communication of the left renal artery with hugely dilated left renal vein suggestive of large arteriovenous fistula. The left main renal artery was occluded by an Amplatzer vascular plug II (C). The final digital subtraction angiography run (D) showing complete occlusion of the fistula
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036345&req=5

Figure 1: Computed tomography (CT) angiography axial (A) image showing gross aneurysmal dilatation of the left renal vein during arterial phase. CT volume rendered (B) confirmed image showing communication of the left renal artery with hugely dilated left renal vein suggestive of large arteriovenous fistula. The left main renal artery was occluded by an Amplatzer vascular plug II (C). The final digital subtraction angiography run (D) showing complete occlusion of the fistula
Mentions: A 32-year-old male patient initially presented with a 6-month history of left flank pain. The pain was dull, intermittent, and non-radiating. He had a history of bullet injury 7 years back in the left flank. On physical examination, a continuous bruit was audible over the left flank. Doppler evaluation revealed a large cystic lesion at the left renal hilum with increased flow velocity and decreased arterial resistance, and mixing of arterial and venous waveform was also observed. A computed tomography angiography (CTA) was performed which revealed contrast opacification of the renal vein during the arterial phase suggesting renal AVF. A giant pseudoaneurysm (PSA) was also seen occupying the mid and lower pole of the left kidney [Figure 1A] measuring 7 cm × 6.5 cm × 6 cm. The main renal artery (MRA) was the possible feeder artery to the AVF which was seen directly opening into the PSA, suggesting an ultrashort segment of fistulous communication. Main renal vein appeared to be directly communicating with the pseudoaneurysm and was also dilated grossly with aneurismal morphology. The morphology and extension of the vascular lesion was well-demonstrated on the volume rendering technique image [Figure 1B].

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Renal arteriovenous fistula (AVF) is often an acquired renal vascular abnormality, usually caused by biopsy, percutaneous nephrostomy, or trauma... Here, we report the endovascular management of a giant renal AVF using Amplatzer vascular plug (AVP)... Because there was hypertrophy of the MRA, a 20-mm AMPLATZER Plug II (St Jude Medical, Inc, St Paul, Minnesota, USA) was placed at the junction of the feeding artery and the PSA [Figure 1C]... Position was then confirmed by angiogram and the device was deployed... Renal AVF is generally secondary to processes invasive to renal parenchyma or renal vascular system (approximately 70%) such as biopsy, percutaneous nephrostomy, and trauma or may be congenital... Coil embolization is now the standard endovascular approach to the management of symptomatic AVF... However, transcatheter embolization of large, high-flow AVF always carries a significant risk for migration of embolic material into the pulmonary arteries... Its migration risk is less than those of coils... Limitations of AVP include need of a 5–9 F sheath and unsuitability of AVP for vessels that are too small or too large... This case illustrates the feasibility of the use of AVP in the treatment of renal AVF... There are no conflicts of interest.

No MeSH data available.


Related in: MedlinePlus