Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization

Management of Renal Artery-Inferior Vena Cava Fistula Following Nephrectomy for Penetrating Trauma

Background: Renal artery to inferior vena cava fistula is a rare event postnephrectomy. We report a case of an adult male in whom a renal artery to inferior vena cava fistula was detected on non-invasive studies following nephrectomy for penetrating trauma. Case Report: A fistula between the right renal artery and inferior vena cava was confirmed with diagnostic angiography. The fistula was successfully embolized using microcoils. Discussion: This case highlights the importance of exploring retroperitoneal hematomas secondary to penetrating trauma.

Amplatzer vascular plug IV in the treatment of high flow renal arteriovenous fistula: Case considerations

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.

Renal Arteriovenous Fistula in a Renal Transplant Recipient: A Case Report and Literature Review

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.

Transarterial embolization of a large high-flow right renal arteriovenous fistula using stents and an across-stent wire-trapping technique

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.

Aortic Customized Stent-Graft Treatment of Postnephrectomy Renal Pedicle Arteriovenous Fistula

A postnephrectomy renal acquired arteriovenous fistula (AVF) is a rare clinical entity that may cause high-output heart failure. Most of the cases are identified time along after surgery. We present a case of a postnephrectomy renal AVF treated with aortic customized stent-graft.

Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

PURPOSE

To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.

MATERIALS AND METHODS

The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.

RESULTS

Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.

CONCLUSION

A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

PURPOSE

We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results.

METHODS

Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared.

RESULTS

Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre- and postoperative eGFR and serum parameters.

CONCLUSION

Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.

False aneurysm of perforating branch of the deep femoral artery-Report of two cases

Pseudoaneurysms of the deep femoral artery are uncommon and occur as a late complication of various traumas. Usually associated with femoral fractures, We report two cases of profunda femoris artery injury which presented as false aneurysm secondary to penetrating trauma. Because of its insidious onset, awareness and careful follow-up are the key issues for the early diagnosis.

Endovascular management of early-onset post-nephrectomy renal arteriovenous fistula: A report of two cases

Purpose:

Here, we report two cases of early-onset post-nephrectomy renal arteriovenous fistula who were successfully managed by implantation of patent ductus arteriosus occluders.

Case report:

Both patients were female, aged 38 and 36 years. They received left renal nephrectomy 9 and 6 months, respectively, with a complaint of chest congestion and dyspnea before admitting to our center. Computed tomographic angiography revealed a huge arteriovenous fistula of the left renal pedicle with a renal venous aneurysm in both patients. The fistulas were isolated by implanting patent ductus arteriosus occluders in the renal artery stumps. Clinical symptoms disappeared after intervention. Computed tomographic angiography confirmed the effectiveness of the occluders during follow-up time. The venous aneurysms shrank to normal size.

Conclusion:

Our experience indicates that post-nephrectomy renal arteriovenous fistula can present as an early complication which can be efficiently managed by endovascular occlusion of the arterial stump by patent ductus arteriosus occluder.

Percutaneous embolization of a postnephrectomy arteriovenous fistula with intervening pseudoaneurysm using the Amplatzer vascular plug 2

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.

Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report

BACKGROUND

Renal arteriovenous fistula (RAVF) is a comparatively rare malformation. Here, we report a case of ruptured RAVF that was successfully treated by catheter embolization.

CASE PRESENTATION

An 89-year-old female was transferred to our institution with massive gross hematuria in March 2011. Plain abdominal computed tomography (CT) revealed dilated left renal pelvis with high-density contents. Hematoma was suspected. Subsequent plain abdominal magnetic resonance imaging revealed left hydronephrosis and blood retention in the dilated left renal pelvis. No renal or ureteral cancer was evident. Hematuria was conservatively treated using hemostatic agents but hematuria persisted. Repeated urinary cytology revealed no malignant cells. On day 9, the patient went into septic and/or hemorrhagic shock. Fluid and catecholamine infusion, blood transfusion, and antibacterial drugs were rapidly initiated, and the patient's general condition gradually improved. Contrast-enhanced abdominal CT revealed marked expansion of the hematoma in the renal pelvis and microaneurysms in the segmental arteries of the left kidney. Inflammation improved, and a left double-J stent was inserted. Selective renal angiography revealed RAVF with microaneurysms in the left segmental arteries; therefore, catheter embolization using metallic coils was performed, which resolved hematuria.

CONCLUSION

We report a case of ruptured renal arteriovenous malformation, which was successfully treated by catheter embolization.

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

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.

Gross hematuria caused by a congenital intrarenal arteriovenous malformation: a case report

Introduction

We report the case of a woman who presented with gross hematuria and was treated with a percutaneous embolization.

Case presentation

A 48-year-old Caucasian woman presented with gross hematuria, left flank pain, and clot retention. The patient had no history of renal trauma, hypertension, urolithiasis, or recent medical intervention with percutaneous instrumentation. The patient did not report any bleeding disorder and was not taking any medication. Her systolic and diastolic blood pressure values were normal at presentation. The patient had anemia (8 mg/dL) and tachycardia (110 bpm). She underwent color and spectral Doppler sonography, multi-slice computed tomography, and angiography of the kidneys, which showed a renal arteriovenous malformation pole on top of the left kidney.

Conclusions

The feeding artery of the arteriovenous malformation was selectively embolized with a microcatheter introduced using a right transfemoral approach. By using this technique, we stopped the bleeding, preserved renal parenchymal function, and relieved the patient's symptoms. The hemodynamic effects associated with the abnormality were also corrected.

Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy

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.

Transcatheter renal artery embolization: clinical applications and techniques

Renal artery embolization is a minimally invasive procedure that is increasingly being used for treatment of a wide range of conditions. The main indications for renal artery embolization include (1) prenephrectomy and preradiofrequency ablation infarction of renal tumors, (2) management of renal angiomyolipomas, (3) palliations of unresectable renal malignancy, (4) renal hemorrhage (life-threatening or chronic debilitating hematuria), (5) arteriovenous fistulas, (6) vascular malformations, (7) renal artery aneurysms and pseudoaneurysms, and other less common indications, such as severe hydronephrosis and hypertension. A variety of embolic materials are available, such as metal coils, sclerosants (glue, Onyx, absolute ethanol, lipiodol), and particulate embolic agents (polyvinyl alcohol particles and embospheres). Selection of the appropriate agent depends on the clinical application, technical and clinical endpoints, as well as the pathology lesion(s) targeted. Renal artery embolization can be performed alone or in combination with remodeling techniques, stent-grafting, and balloon- or stent-assisted coiling in more complicated cases. The procedure is generally regarded as safe and effective for diverse applications and is considered as an evolving area in the field of endoluminal therapy.