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Duc VT, Duong N, Phong NT, Nam NH, Quoc DA, Cuong T, Huy NH, Duy TL, Chien PC. Large renal arteriovenous fistula treated by embolization: a case report. Radiol Case Rep 2021; 16:2289-2294. [PMID: 34194592 PMCID: PMC8233104 DOI: 10.1016/j.radcr.2021.05.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022] Open
Abstract
Renal arteriovenous fistula (RAVF) is an uncommon vascular malformation of the kidney, which can be congenital, acquired or idiopathic. Although most patients are asymptomatic, RAVF can lead to hypertension, heart failure, renal insufficiency, hematuria, and progressive increase in size of renal vessels. Diagnosis is aided by radiological studies, with digital subtraction angiography as a gold standard. Besides, ultrasound with color Doppler and computed tomography angiography are noninvasive imaging techniques and can be useful for planning the treatment. A large fistula are generally treated by nephrectomy. Intervention can ameliorate the hemodynamic effects of high flow and to preserve the renal parenchymal function. Although endovascular therapy may be challenging due to the large size and high flow of fistula, this report describes a case of huge RAVF was successfully treated by embolization instead of surgery.
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Affiliation(s)
- V T Duc
- Department of Radiology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Diagnostic Imaging, University Medical Centre, Ho Chi Minh City, Vietnam
| | - Nqt Duong
- Department of Radiology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Diagnostic Imaging, University Medical Centre, Ho Chi Minh City, Vietnam
| | - N T Phong
- Department of Radiology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - N H Nam
- Department of Radiology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - D A Quoc
- Department of Pediatric Heart Surgery, University Medical Centre, Ho Chi Minh City, Vietnam
| | - Ttq Cuong
- Department of Diagnostic Imaging, University Medical Centre, Ho Chi Minh City, Vietnam
| | - N H Huy
- Department of Diagnostic Imaging, University Medical Centre, Ho Chi Minh City, Vietnam
| | - T L Duy
- Department of Diagnostic Imaging, University Medical Centre, Ho Chi Minh City, Vietnam
| | - P C Chien
- Department of Diagnostic Imaging, University Medical Centre, Ho Chi Minh City, Vietnam
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2
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Catelli A, Loiudice G, Corvino A, Castaldo A, Bracale UM, Quarantelli M, Venetucci P. Amplatzer vascular plug IV in the treatment of high flow renal arteriovenous fistula: Case considerations. Radiol Case Rep 2020; 15:1442-1445. [PMID: 32642014 PMCID: PMC7334554 DOI: 10.1016/j.radcr.2020.05.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 01/22/2023] Open
Abstract
Renal arteriovenous fistula is classified into idiopathic, acquired and congenital. Endovascular therapy has become the gold standard compared to surgery. We present the embolization procedure of a renal fistula postbiopsy in a 57-year-old female patient through the use of St. Jude Medical Amplatzer vascular Plug IV. Although numerous embolizing agents are available, plug type IV has numerous advantages in terms of procedure times, speed of embolization and precision of the occlusion, but with a relative increase in costs.
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Affiliation(s)
- Antonio Catelli
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Giovanni Loiudice
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", I-80133 Naples, Italy
| | - Anna Castaldo
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | | | - Mario Quarantelli
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Pietro Venetucci
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
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3
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Jardinet T, Bonne L, Oyen R, Maleux G. Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization. Vasc Endovascular Surg 2020; 54:240-246. [DOI: 10.1177/1538574419897500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Methods: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients’ demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients’ electronic medical records. Results: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. Conclusion: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.
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Affiliation(s)
- Thomas Jardinet
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Endovascular Occlusion of a Renal Arteriovenous Fistula with Renal Vein Aneurysm Formation for Rupture Prevention. Case Rep Vasc Med 2020; 2019:8530641. [PMID: 31915564 PMCID: PMC6930724 DOI: 10.1155/2019/8530641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the effectiveness of left renal artery (LRA) occlusion using Amplatzer Vascular Plug (AVP) II as treatment for a high-flow renal arteriovenous fistula (RAVF) with multiple renal vein aneurysms (RVA) to prevent aneurysm rupture and cardiac decompensation. Case Report A 59-year-old female suffering from a post-traumatic RAVF presented with tachycardia and increased cardiac output (CO). Doppler ultrasonography and computed tomography (CT) scan revealed a high-flow RAVF with multiple RVAs and unilateral critically reduced kidney function. Appreciating recent interventional therapeutic advances, the patient was treated with endovascular placement of AVP II into the left renal artery (LRA) resulting in complete occlusion of the RAVF to effectively reduce the risk of RVA rupture and cardiac decompensation. No anti-platelet medication was administrated after the occlusion of the LRA. The patient's physical capacity improved since right heart volume strain was normalized, and CO was reduced. Conclusion Transbrachial AVP II occlusion of the LRA is effective to occlude high-flow RAVFs to prevent risk of life-threatening RVA rupture. Additional follow-up is warranted to verify long-term effectiveness of this approach.
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Shie RF, Su TW, Hsu MY, Chu SY, Ko PJ. Transarterial embolization of a large high-flow right renal arteriovenous fistula using stents and an across-stent wire-trapping technique. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:122-127. [PMID: 31193393 PMCID: PMC6529687 DOI: 10.1016/j.jvscit.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
Abstract
Renal arteriovenous fistulas (AVFs) are rare vascular abnormalities. Their high-flow nature may result in increased cardiac output and lead to heart failure. Transcatheter endovascular management of renal AVFs with various embolization materials has been the treatment of choice in recent years. Embolization of large renal AVFs poses a risk of embolization through the AVF to the pulmonary circulation. Herein, we present the case of a patient whose large high-flow renal AVF was treated by a novel method involving the use of a bare stent and detachable metallic coils—called a wire-trapping technique—as well as compare this method with vascular plugs.
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Affiliation(s)
- Ren-Fu Shie
- Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ta-Wei Su
- Chang Gung University, Taoyuan, Taiwan.,Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Yi Hsu
- Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sung-Yu Chu
- Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Jen Ko
- Chang Gung University, Taoyuan, Taiwan.,Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney. CVIR Endovasc 2019; 1:21. [PMID: 30652152 PMCID: PMC6319512 DOI: 10.1186/s42155-018-0029-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/14/2018] [Indexed: 11/25/2022] Open
Abstract
Background In this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve. Case presentation Seventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline. Conclusions Percutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein.
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Ohashi T, Nishikimi T, Hattori K, Yamauchi Y, Ishida R, Yamada H, Yokoi K, Kobayashi H. [RENAL ARTERIOVENOUS FISTULA (ANEURYSMAL TYPE) TREATED BY NEPHRECTOMY UNDER BALLOON CATHETER OCCLUSION OF RENAL ARTERY: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2018; 109:116-121. [PMID: 31006741 DOI: 10.5980/jpnjurol.109.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 60-year-old man presented with leg edema and shortness of breath. He was being treated with medication for chronic heart failure for the past 3 years and had been in a traffic accident when he was 13 years old. Computed tomography showed a huge right renal arteriovenous fistula (AVF). The right renal artery measured 16 mm in diameter, the renal aneurysm was observed to be 60 mm, renal vein 87 mm, and the inferior vena cava 60 mm in diameter. His high-output heart failure was attributed to his right renal AVF, for which treatment was deemed necessary. Due to the risk of pulmonary embolism associated with transcatheter arterial embolization, we performed a nephrectomy with temporary interruption of renal blood flow using a balloon catheter. He was observed to be asymptomatic immediately after surgery.
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Affiliation(s)
| | | | | | | | - Ryo Ishida
- Department of Urology, Nagoya Daini Red Cross Hospital
| | | | - Keisuke Yokoi
- Department of Urology, Nagoya Daini Red Cross Hospital
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8
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Keller WW, Miserlis D, Suh M, Dale M, Sayyed S, Baxter BT. Recurrent Admissions for Respiratory Distress Caused by Large Renal AVF. Vasc Endovascular Surg 2016; 50:57-9. [PMID: 26912528 DOI: 10.1177/1538574415627871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal arteriovenous fistulas (AVFs) are an uncommon complication of nephrectomy. In this report, we present the case of a 66-year-old female presenting with progressive dyspnea on exertion and exercise intolerance. She was diagnosed and treated for adult onset reactive airway disease. The patient underwent nephrectomy at age 18 secondary to recurrent pyelonephritis from vesicoureteral reflux. She underwent a surveillance computed tomography (CT) scan to evaluate a small ascending aneurysm that was initially detected on cardiac echocardiogram. A large left renal AVF was detected incidentally on the CT scan. The fistula was successfully treated by ligation of the renal artery with resolution of pulmonary symptoms.
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Affiliation(s)
| | | | - Melissa Suh
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew Dale
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Samer Sayyed
- University of Nebraska Medical Center, Omaha, NE, USA
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9
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Maruno M, Kiyosue H, Tanoue S, Hongo N, Matsumoto S, Mori H, Sagara Y, Kashiwagi J. Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture. Radiographics 2016; 36:580-95. [PMID: 26871987 DOI: 10.1148/rg.2016150124] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Miyuki Maruno
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Hiro Kiyosue
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Shuichi Tanoue
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Norio Hongo
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Shunro Matsumoto
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Hiromu Mori
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Yoshiko Sagara
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Junji Kashiwagi
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
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10
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Affiliation(s)
- Natalia C Berry
- From Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
| | | | - Joshua A Beckman
- From Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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11
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Abdel-Aal AK, Elsabbagh A, Soliman H, Hamed M, Underwood E, Saddekni S. Percutaneous embolization of a postnephrectomy arteriovenous fistula with intervening pseudoaneurysm using the Amplatzer vascular plug 2. Vasc Endovascular Surg 2014; 48:516-21. [PMID: 25487250 DOI: 10.1177/1538574414561230] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although renal arteriovenous fistula (AVF) is an uncommon condition, it may lead to high cardiac output heart failure and renal insufficiency. Recently, percutaneous transcatheter embolization has replaced traditional surgery as the first line of treatment. We report a case of a 68-year-old male who presented with a renal AVF and was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug 2 (AVP 2; St Jude Medical, Plymouth, Minnesota) through an arterial access. To our knowledge, the use of AVP 2 device in the treatment of renal AVF as a single embolotherapy device through the transarterial route has not been previously reported in the literature. Our technique demonstrates the feasibility and safety of AVP 2 device in the treatment of renal AVF.
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Affiliation(s)
| | - Ahmed Elsabbagh
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hesham Soliman
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maysoon Hamed
- Department of Family Medicine, University of Alabama, Tuscaloosa, AL, USA
| | - Edgar Underwood
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Souheil Saddekni
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Stefańczyk L, Religa W, Kasprzak J, Szymczyk K, Polguj M. Giant Postnephrectomy Arteriovenous Fistula in a Patient with Tuberous Sclerosis and Anomalous Inferior Vena Cava: Treatment with Amplatzer Vascular Plug Embolization. Ann Vasc Surg 2014; 28:1318.e7-10. [DOI: 10.1016/j.avsg.2013.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
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13
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Complete Renal Artery Embolization in a Comorbid Patient with an Arteriovenous Malformation. Case Rep Urol 2014; 2014:856059. [PMID: 24716086 PMCID: PMC3971545 DOI: 10.1155/2014/856059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/18/2014] [Indexed: 11/23/2022] Open
Abstract
Renal arteriovenous malformations are uncommon and are rarely a cause for presentation. However, they can occasionally pose life-threatening problems. We present a case of an elderly female who underwent a complete left renal artery embolization, following a difficult presentation complicated by advanced dementia and multiple comorbidities. This is the first documented case of complete renal artery embolisation used to treat a renal AVM.
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14
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Large Renal Arteriovenous Fistula With Left-Sided Inferior Vena Cava. Ann Vasc Surg 2013; 27:1185.e9-12. [DOI: 10.1016/j.avsg.2012.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 11/04/2012] [Accepted: 11/24/2012] [Indexed: 11/18/2022]
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15
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Kayser O, Schäfer P. Transcatheter Amplatzer vascular plug-embolization of a giant postnephrectomy arteriovenous fistula combined with an aneurysm of the renal pedicle by through-and-through, arteriovenous access. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2013; 11:Doc01. [PMID: 23326248 PMCID: PMC3546418 DOI: 10.3205/000169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 11/26/2012] [Indexed: 11/30/2022]
Abstract
Although endovascular transcatheter embolization of arteriovenous fistulas is minimally invasive, the torrential flow prevailing within a fistula implies the risk of migration of the deployed embolization devices into the downstream venous and pulmonary circulation. We present the endovascular treatment of a giant postnephrectomy arteriovenous fistula between the right renal pedicle and the residual renal vein in a 63-year-old man. The purpose of this case report is to demonstrate that the Amplatzer vascular plug (AVP) can be safely positioned to embolize even relatively large arteriovenous fistulas (AVFs). Secondly, we illustrate that this occluder can even be introduced to the fistula via a transvenous catheter in cases where it is initially not possible to advance the deployment-catheter through a tortuous feeder artery. Migration of the vascular plug was ruled out at follow-up 4 months subsequently to the intervention. Thus, the Amplatzer vascular plug and the arteriovenous through-and-through guide wire access with subsequent transvenous deployment should be considered in similar cases.
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Affiliation(s)
- Ole Kayser
- Department of Radiology, University Hospital Schleswig-Holstein, Kiel, Germany.
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16
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Percutaneous embolization of idiopathic renal arteriovenous fistula using Amplatzer vascular plug II. Int Urol Nephrol 2012; 45:61-8. [PMID: 23266863 DOI: 10.1007/s11255-012-0358-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/08/2012] [Indexed: 12/16/2022]
Abstract
Renal arteriovenous fistula (AVF) presents a rare but important condition that can be acquired, congenital, or idiopathic. Embolization techniques have recently been considered the first-line therapy in the treatment of these lesions, but they carry a possible high risk of distal migration of embolic agents into the venous and pulmonary circulation. This risk is especially important with large, high-flow fistulas. In this report, we present a case in which a 31-year-old man with a symptomatic idiopathic AVF was treated with embolization using the Amplatzer vascular plug II after unsuccessful superselective embolization using coils. This method allowed for complete occlusion of the high-flow fistula with good preservation of arterial supply to the renal parenchyma.
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17
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The Amplatzer Vascular Plug: A Review of the Device and its Clinical Applications. Cardiovasc Intervent Radiol 2012; 35:725-40. [DOI: 10.1007/s00270-012-0387-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/25/2012] [Indexed: 12/16/2022]
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18
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Numasawa Y, Kawamura A, Hashimoto S, Endo A, Yuasa S, Maekawa Y, Kuribayashi S, Fukuda K. Successful percutaneous coil embolization of coronary-pulmonary, -carotid, and -internal mammary artery fistulas. Heart Vessels 2011; 27:331-6. [PMID: 21735204 DOI: 10.1007/s00380-011-0172-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 06/17/2011] [Indexed: 01/01/2023]
Abstract
We herein describe a 57-year-old man with coronary-pulmonary artery fistulas that had abnormal connections between the left common carotid artery and the left internal mammary artery. The patient was treated with percutaneous coil embolization using antegrade (via the coronary artery) and retrograde (via the pulmonary artery) approaches. Coronary artery fistulas have diverse anatomical variations, and it is important to thoroughly evaluate the anatomy before beginning any mode of treatment, surgical or endovascular. In the case reported herein, multislice computed tomography played a pivotal role in the preprocedure evaluation.
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Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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Li P, Zhao XX, Zheng X, Qin YW. Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results. Heart Vessels 2011; 27:405-10. [PMID: 21643813 DOI: 10.1007/s00380-011-0155-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
Abstract
With the development of interventional techniques and devices, transcatheter closure of perimembranous ventricular septal defect has been widely performed. However, there has been a lack of long-term follow-up results about postoperative ECG changes of PmVSD patients. We report our experience of early and late arrhythmias after transcatheter closure of PmVSD with a modified double-disk occluder (MDVO). We performed a retrospective review of 79 patients (47 males, 32 females) between September 2002 and May 2007 who underwent transcatheter closure of perimembranous ventricular septal defect. Symmetric and asymmetric PmVSD occluders were used. The diameter of the evaluated defects ranged from 3 to 12 mm, as measured by TTE and 3 to 15 mm by left ventriculography. Most cases of PmVSD were treated successfully with a single procedure, resulting in a successful closure rate of 97% (77/79 patients). There was no death in any of the patients. After the operation, 79 patients were followed-up for a range of 10-76 months (35.3 ± 17.4 months). In this series, 11 cases of incomplete right bundle branch block and five cases of complete right bundle branch block occurred during the early period after operation. During long-term follow-up, these issues declined in prevalence to five and four cases, respectively. Moreover, reversible third-degree AVB occurred during closure or after the procedure, and two of the three patients with reversible AVB received a temporary heart pacemaker implantation. These patients recovered 1 h, 6 days, and 9 days later, respectively. During 10-76 months of follow-up, no complications occurred in any of the patients, including residual shunt, severe aortic valve, or tricuspid valve regurgitation. Device closure of perimembranous ventricular septal defects with a modified double-disk occluder (MDVO) resulted in excellent closure rates and acceptably low arrhythmia rates.
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Affiliation(s)
- Pan Li
- Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, People's Republic of China
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