Large Renal Arteriovenous Fistula With Left-Sided Inferior Vena Cava

Management of Complex Traumatic Renal Artery-Inferior Vena Cava Fistula: A Case Report and Review of the Literature

BACKGROUND

Renal artery-inferior vena cava (IVC) fistula is usually caused by penetrating injury to the back. However, it is a very rarely reported entity with only 20 cases reported in the literature. They may present acutely with hemodynamic instability or chronically as congestive heart failure. A thorough examination and adequate imaging are required to avoid missing such injuries.

CASE PRESENTATION

A 28-year-old gentleman presented after sustaining stab injury to the back. The stab had penetrated the renal artery and IVC, leading to arteriovenous fistula. He was managed surgically, as he went into hemorrhagic shock, with a successful outcome. The case is also unique as an accessory renal artery was also involved in the fistula.

CONCLUSION

Early identification and management of renal artery-IVC fistula is important to ensure a successful outcome. Such fistulas can be managed by either endovascular approach or surgical approach. The decision of approach depends on the level of expertise available and hemodynamic status of the patient.

Embolization of high-output idiopathic renal arteriovenous fistula primarily using an atrial septal defect occluder via venous access: a case report

Background

The case report is to evaluate the efficacy and safety of embolization of a high-output idiopathic renal arteriovenous fistula (IRAVF) with an atrial septal defect occluder (ASDO) via venous access.

Case presentation

A 57-year-old male diagnosed with high-output IRAVF received embolization with an ASDO via renal venous access and compact occlusion with 3 vascular plugs and a detachable elastic coil. The IRAVF was successfully occluded. After a follow-up of 2 months, renal arterial computed tomography angiography (CTA) showed the precise location of the ASDO. No complications were observed after 2 years’ follow-up.

Conclusions

Based on present results, embolization of a high-output IRAVF with an ASDO via venous access might be an efficient and safe method.

Transarterial embolisation for congenital renal arteriovenous malformations improves clinical condition even with partial obliteration

AIM

To evaluate the efficacy and safety of transarterial embolisation (TAE), used to treat congenital renal arteriovenous malformations (CRAVMs).

MATERIALS AND METHODS

The medical records were searched retrospectively to identify patients who underwent TAE to treat CRAVM from January 2003 to August 2015. Patient demographics, clinical presentations, and imaging findings were reviewed. TAE outcomes, including complete or partial obliteration, clinical success, complications, renal function changes, and relapse of symptoms or signs after the final TAE, were assessed.

RESULTS

Over the 12-year period, 16 patients (nine male, seven female; median age, 47 years) who underwent 21 TAE procedures to treat 16 CRAVMs were enrolled in the study. The most common clinical presentation was haematuria (81.3%). Thirteen patients (81.3%) had cirsoid and three (18.7%) had aneurysmal CRAVMs. Of the 16 CRAVMs, 11 (68.8%) were peripheral, four (25%) were central, and one (6.3%) was both peripheral and central. The complete obliteration rate was 56.3%. The clinical success rate was 87.5% over a median follow-up period of 398.5 days. Two (9.5%) major complications and 14 (66.7%) minor complications were encountered. No statistically significant change in renal function was evident after TAE.

CONCLUSION

TAE was safe and effective when used to treat CRAVM; the complication profile was acceptable and renal function was preserved. TAE improved the clinical condition of CRAVM patients even when obliteration was only partial.