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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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Renal Arteriovenous Fistula in a Renal Transplant Recipient: A Case Report and Literature Review. Transplant Direct 2020; 6:e513. [PMID: 32047841 PMCID: PMC6964933 DOI: 10.1097/txd.0000000000000958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background Renal arteriovenous fistula (rAVF) is a rare complication after a total nephrectomy, with only 72 cases reported in the last literature review published in 1997. AVF has never been described in a renal transplant recipient, and the possible consequences of hemodetournement on the graft function are unknown. Methods We hereby reported the first case of rAVF occurring in a renal transplant recipient and analyzed all cases of postnephrectomy rAVF reported between 1997 and 2017. Results A 75-year-old woman who underwent a right nephrectomy and kidney transplant 16 years earlier, and complaining of mild exercise dyspnea, was discovered with a lumbar continuous murmur. Echocardiography showed a moderate to severe dilatation of the left ventricle, with a decreased ejection fraction. Serum creatinine was slightly raised but returned to normal value with hydration. An injected computed tomography scan demonstrated a communication between the stump of the right renal artery and inferior vena cava. Total occlusion of the rAVF was obtained with Amplatzer plug and coils placed in the distal renal stump, just upstream of rAVF. Exercise dyspnea disappeared immediately, and regression of left ventricular dilatation was objectified at 6-month echocardiography follow-up. Conclusions Postnephrectomy rAVF is rare, frequently diagnosed late, and may be responsible for high-output heart failure by left-to-right shunt, with abdominal/lumbar bruit being the only manifestation. Renal complications concern 15% of the patients. Endovascular procedure is nowadays the treatment of choice. Occluding rAVF permits cardiac hemodynamic features and heart failure symptoms resolution.
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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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Kimura Y, Osuga K, Ono Y, Nakazawa T, Higashihara H, Tomiyama N. Long-Term Outcomes of Selective Renal Artery Embolization for Renal Arteriovenous Fistulae with Dilated Venous Sac. J Vasc Interv Radiol 2018; 29:952-957. [PMID: 29628300 DOI: 10.1016/j.jvir.2018.01.763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To retrospectively evaluate the role of selective renal artery embolization for renal arteriovenous fistulae (AVFs) with dilated venous sac. MATERIALS AND METHODS Between 2002 and 2015, 14 patients (7 men and 7 women; mean age, 60 years) with a single renal AVF with dilated venous sac underwent selective renal artery embolization. Three patients presented with gross hematuria, 4 presented with occult blood in urine, and 1 presented with chronic heart failure. Five patients had a history of renal biopsy or partial nephrectomy. Embolic agents used included pushable fibered coils, detachable microcoils, hydrogel coils, N-butyl 2-cyanoactylate, and/or absolute ethanol. Technical success was defined as complete angiographic occlusion of the renal AVF without visualization of the venous sac. Clinical success was defined as the disappearance of the AVF on ultrasound and contrast-enhanced computed tomography, without any symptoms. RESULTS Fifteen sessions of selective renal artery embolization were performed. Technical success was achieved in 13 sessions (86.7%). Clinical success was achieved in 13 patients (92.9%) after a mean follow-up of 48 months (range, 6-155 months). Two major complications occurred-renal vein thrombosis (n = 1) and renovascular hypertension (n = 1)-and were successfully managed with warfarin and an angiotensin-II receptor blocker, respectively. The former patient required re-embolization because of recanalization. No significant changes were observed in the mean serum creatinine level (.86 mg/dL vs .85 mg/dL; P = .67) and the mean estimated glomerular filtration rate (66.0 mL/min/1.73m2 vs 67.4 mL/min/1.73m2; P = .4) after 6 months. CONCLUSIONS Selective renal artery embolization is a safe and effective treatment for renal AVFs with dilated venous sac.
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Affiliation(s)
- Yasushi Kimura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuro Nakazawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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5
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Successful treatment of a renal arteriovenous fistula with pulmonary hypertension occurring 38 years after nephrectomy. Anatol J Cardiol 2018. [PMID: 29537974 PMCID: PMC5998843 DOI: 10.14744/anatoljcardiol.2018.65693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sherer BA, Chow AK, Newsome MJ, Coogan CL, Prasad SM, Latchamsetty KC. En Bloc Stapling of the Renal Hilum During Laparoscopic Nephrectomy: A Double-institutional Analysis of Safety and Efficacy. Urology 2017; 105:69-75. [PMID: 28366703 DOI: 10.1016/j.urology.2017.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the safety and efficacy of en bloc stapling of the renal hilum (EBSH) during laparoscopic nephrectomy (LNx) in a large double-institution cohort with an extended follow-up period. METHODS We performed a retrospective review of patients undergoing LNx with EBSH between 2008 and 2014 at 2 academic medical centers. Data analyzed included tumor size, tumor pathology, operative time, estimated blood loss, and perioperative or postoperative complications. Evaluation of arteriovenous fistula (AVF) formation was assessed by postoperative imaging studies, physical examination, or new-onset diastolic hypertension. RESULTS A total of 428 patients (mean age: 63 years) underwent LNx, of which there were a total of 433 renal units with EBSH (226 left renal units, 207 right renal units). Mean operative time was 169 minutes (range: 51-489 minutes). Mean estimated blood loss was 155 mL (range: 5 mL-2000 mL). Mean tumor size was 5.6 cm (range: 0.9-14.5 cm). EBSH was performed on 69 patients with chronic infectious and inflammatory benign conditions. Three hundred (70%) patients received post-procedural imaging. No patients developed clinical or radiographic evidence of AVF at a mean follow-up of 51 months. CONCLUSION EBSH during LNx is efficient, effective, and safe. This large series lends further support that EBSH during LNx may not be associated with any significant risk of AVF formation at extended follow-up. We advocate that this technique is a safe alternative to ligating the renal artery and vein during LNx.
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7
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Khawaja AT, McLean GK, Srinivasan V. Successful Intervention for High-Output Cardiac Failure Caused by Massive Renal Arteriovenous Fistula. Angiology 2016; 55:205-8. [PMID: 15026876 DOI: 10.1177/000331970405500213] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Renal arteriovenous fistula is a rare clinical entity that may produce high-output cardiac failure. This report describes the case of an 81-year-old woman in whom recurrent episodes of congestive heart failure developed over a relatively short time. A massive renal arteriovenous fistula was visualized by CT scan and arteriography. Successful embolization was performed under hemodynamic monitoring with complete resolution of the patient’s symptoms.
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Affiliation(s)
- Azimuddin T Khawaja
- Western Pennsylvania Hospital, Temple University School of Medicine, Pittsburgh PA 15224, USA.
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8
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Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol 2011; 185:2061-5. [PMID: 21496835 DOI: 10.1016/j.juro.2011.02.049] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE We describe the presentation, endovascular management and functional outcomes of 15 patients with renal arterial pseudoaneurysm following open and laparoscopic partial nephrectomy. MATERIALS AND METHODS An institutional review board approved, Health Insurance Portability and Accountability Act compliant retrospective review of a prospectively maintained database revealed that 7 of 1,160 patients who underwent open partial nephrectomy and 8 of 301 treated with laparoscopic partial nephrectomy were diagnosed with a pseudoaneurysm of a renal artery branch between 2003 and 2010. Some cases were associated with arteriovenous fistula. RESULTS Diagnosis of pseudoaneurysm was made a median of 14 days after surgery. Gross hematuria was the most frequent symptom. Median estimated glomerular filtration rate measurements at the preoperative evaluation, postoperatively, on the day the vascular lesion was diagnosed, after embolization and at the last followup were 62, 55, 55, 56 and 58 ml/minute/1.73 m(2), respectively. Median followup was 7.8 months. All patients underwent angiography and superselective coil embolization of 1 or more pseudoaneurysms with or without arteriovenous fistula. Eleven patients had immediate cessation of symptoms while 4 had persistent gross hematuria after the procedure. Of these 4 patients 2 were treated with bedside care, 1 required repeat embolization with thrombin, which was successful, and the remaining patient had coagulopathy and underwent radical nephrectomy for persistent bleeding. CONCLUSIONS Pseudoaneurysms and arteriovenous fistulas of the renal artery are rare complications of partial nephrectomy. Presentation is often delayed. Superselective coil embolization is a safe, minimally invasive treatment option that usually solves the clinical problem and preserves renal function.
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Affiliation(s)
- Tarek P Ghoneim
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Abdel-Gawad EA, Housseini AM, Cherry KJ, Bonatti H, Maged IM, Norton PT, Hagspiel KD. CT Angiography of Renal Arteriovenous Fistulae: A Report of Two Cases. Vasc Endovascular Surg 2009; 43:416-20. [DOI: 10.1177/1538574409340588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal arteriovenous fistulas (AVFs) are rare abnormal communications between the arterial and venous circulations that can be congenital or acquired. We describe the multidetector computed tomography angiography (MDCTA) appearance of 2 cases of renal AVF, one with the cirsoid and one with the aneurysmal subtype, and the impact of these findings on therapeutic decision making and treatment follow-up.
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Affiliation(s)
- Ehab A. Abdel-Gawad
- Department of Radiology, El Menia University, El Menia, Egypt, Department of Radiology University of Virginia Health System, Charlottesville, Virginia
| | - Ahmed M. Housseini
- Department of Radiology, Suez Canal University, Ismailia, Egypt, Department of Radiology University of Virginia Health System, Charlottesville, Virginia
| | - Kenneth J. Cherry
- Department of Surgery (KJC, HB), University of Virginia Health System, Charlottesville, Virginia
| | - Hugo Bonatti
- Department of Surgery (KJC, HB), University of Virginia Health System, Charlottesville, Virginia
| | - Ismaeel M. Maged
- Department of Radiology University of Virginia Health System, Charlottesville, Virginia, Department of Radiology, Suez Canal University, Ismailia, Egypt
| | - Patrick T. Norton
- Department of Radiology University of Virginia Health System, Charlottesville, Virginia
| | - Klaus D. Hagspiel
- Department of Radiology University of Virginia Health System, Charlottesville, Virginia,
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10
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Littlejohn MG, Allaf N, Butterfield S. Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava. J Radiol Case Rep 2009; 3:3-6. [PMID: 22470611 DOI: 10.3941/jrcr.v3i1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA) and the inferior vena cava (IVC), successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ) obstruction and recurrent pyelonephritis. It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.
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11
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Abstract
Urinary tract injury occurs in 10% of all abdominal trauma patients, and the kidney is the most commonly injured organ in the urinary tract. CT with contrast enhancement is the modality of choice for cross-sectional imaging of renal trauma because it quickly and accurately can demonstrate injury to the renal parenchyma, renal pedicles, and associated abdominal or retroperitoneal organs. This article reviews the mechanism, clinical features, imaging modalities, and CT imaging findings according to the classification of the renal trauma. Trauma to underlying abnormal kidneys, iatrogenic renal injuries, and complications of renal trauma are reviewed also.
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Affiliation(s)
- Young Joon Lee
- Department of Diagnostic Radiology, Division of Abdominal Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea, 505 Banpo-dong Seocho-gu, Seoul 137-701, Republic of Korea
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12
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Arzoz Fàbregas M, Ibarz Servio L, Bayona Areñas S, Bernal Salguero S, Muchart Masaller J, Saladié Roig JM. [Arteriovenous fistula of the renal stump after nephrectomy]. Actas Urol Esp 2007; 31:796-9. [PMID: 17902479 DOI: 10.1016/s0210-4806(07)73727-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature.
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Affiliation(s)
- M Arzoz Fàbregas
- Servicio de Urología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona.
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13
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Pressacco J, Hudon G, Tanguay JF, Ugolini P. MR Angiography of Renal-Hepatic Arteriovenous Malformation. AJR Am J Roentgenol 2007; 189:W111-2. [PMID: 17646433 DOI: 10.2214/ajr.05.0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Josephine Pressacco
- Department of Radiology, Montreal Heart Institute, 5000 Belanger St., Montreal, QC, Canada HIT 1C8
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14
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Bozgeyik Z, Ozdemir H, Orhan I, Cihangiroglu M, Cetinkaya Z. Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization. Emerg Radiol 2007; 15:119-22. [PMID: 17593408 DOI: 10.1007/s10140-007-0646-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 06/06/2007] [Indexed: 11/28/2022]
Abstract
Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.
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Affiliation(s)
- Zulkif Bozgeyik
- Department of Radiology, Faculty of Medicine, Firat University, 23119 Elazig, Turkey.
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15
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Bajraktari G, Rexhepaj N, Bakalli A, Shaqiri G, Osmani E, Vokrri L, Elezi S. Remission of high-output heart failure after surgical repair of 30-month arteriovenous femoral fistula: case report. Heart Surg Forum 2005; 8:E118-20. [PMID: 15799900 DOI: 10.1532/hsf98.20041172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present a 15-year-old male patient who was admitted to our hospital because of breathlessness and palpitations at minimal physical effort (New York Heart Association class II). The patient had a history of an abdominal and left thigh firearm wound that was surgically treated 30 months earlier. Auscultation over the left femoral groin region revealed a systolodiastolic murmur. X-ray examination of the chest demonstrated significant cardiomegaly. Transthoracic echocardiography revealed an enlargement of 4 cardiac chambers, as well as significant mitral and tricuspid regurgitation. Vascular ultrasound of the femoral artery and vein confirmed the diagnosis of a traumatic arteriovenous fistula. The patient underwent surgical correction of the fistula, after which the symptoms subsided rapidly. Follow-up echocardiography performed 2 months after surgical repair showed a substantial reduction of cardiac size and a nearly complete absence of valvular regurgitations. This case highlights the importance of the recognition of arteriovenous fistulas as a cause of unexpected heart failure and demonstrates that the condition may improve substantially and rapidly after fistula correction.
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Affiliation(s)
- Gani Bajraktari
- Internal Medicine Clinic, University Clinical Centre, Prishtina, Kosovo.
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16
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Rapp DE, Orvieto MA, Gerber GS, Johnston WK, Wolf JS, Shalhav AL. En bloc stapling of renal hilum during laparoscopic nephrectomy and nephroureterectomy. Urology 2004; 64:655-9. [PMID: 15491693 DOI: 10.1016/j.urology.2004.05.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 05/26/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the safety and advisability of en bloc mass stapling of the renal pedicle during difficult laparoscopic nephrectomy to avoid conversion to an open procedure. METHODS A retrospective chart review was performed of 433 consecutive patients undergoing laparoscopic simple or radical nephrectomy or laparoscopic nephroureterectomy between August 1998 and July 2003 by two surgeons. In all cases of en bloc hilar ligation, a stapler was deployed across the renal hilum without individual dissection of the renal artery and vein. RESULTS The overall incidence of en bloc ligation was 6.0% (26 of 433 patients). The reasons for en bloc ligation were a difficult hilar dissection and/or the appearance of the renal hilum in 21 cases and urgent ligation secondary to bleeding in 5 cases. No correlation was found between surgeon experience and the frequency of en bloc ligation. No immediate or short-term complications related to this method of hilar division were observed with a mean follow-up of 26 months. CONCLUSIONS In this study, no cases of arteriovenous fistula development occurred after en bloc stapling of the renal pedicle. Long-term follow-up is needed, because arteriovenous fistula development may be a late complication of nephrectomy. Although we do not advocate the generalized use of en bloc division of the renal pedicle, early data suggest that en bloc stapling can be performed to avoid conversion to an open procedure with no related short-term complications.
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Affiliation(s)
- David E Rapp
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA
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17
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Kocakoc E, Poyraz AK, Cetinkaya Z, Bozgeyik Z. Postnephrectomy renal arteriovenous fistula. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:965-968. [PMID: 15292566 DOI: 10.7863/jum.2004.23.7.965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Firat University Faculty of Medicine, Elazig, Turkey.
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18
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Durakoglugil ME, Kaya MG, Boyaci B, Cengel A. High Output Heart Failure 8 Months After an Acquired Arteriovenous Fistula. ACTA ACUST UNITED AC 2003; 44:805-9. [PMID: 14587663 DOI: 10.1536/jhj.44.805] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congestive heart failure (CHF) due to hyperkinetic states can occur in systemic diseases and in arteriovenous fistulas. An 18 year old Turkish male patient complaining of dyspnea and palpitations, who had suffered a stab wound to his abdomen eight months earlier, was admitted to our clinic. Auscultation revealed a systolodiastolic murmur over the entire abdomen. Chest x-rays demonstrated significant cardiomegaly. Echocardiography revealed biatrial enlargement and significant mitral and tricuspid regurgitation accompanied by dilatation of the inferior vena cava. Right heart catheterization showed increased oxygen saturation at the inferior vena cava. A diagnosis of an aortocaval fistula was made by aortography. The symptoms subsided and valvular regurgitations ceased alter surgical correction. This rare case demonstrates the significance of routine physical examination and history of the patient.
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