Endovascular Occlusion of a Renal Arteriovenous Fistula with Renal Vein Aneurysm Formation for Rupture Prevention.

Yae Hyun Rhee,Hubert Schelzig,Markus Udo Wagenhäuser,Neslihan Ertas,Roberto Sansone,Nikolaos Floros,Lucas Busch,Joscha Mulorz

doi:10.1155/2019/8530641

Yae Hyun Rhee, Hubert Schelzig + Show 6 more

Open Access

https://doi.org/10.1155/2019/8530641

Copy DOI

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.

Highlights

Renal arteriovenous stula (RAVF) is a rare entity with a rate of incidence less than 0.04% on post-mortem histopathological examinations [1]. e most common symptoms of renal arteriovenous fistula (RAVF) include abdominal bruit, gross or micro-haematuria, diastolic arterial hypertension and increased cardiac output
Appreciating recent interventional therapeutic advances, the patient was treated with endovascular placement of Amplatzer Vascular Plug (AVP) II into the le renal artery (LRA) resulting in complete occlusion of the RAVF to e ectively reduce the risk of renal vein aneurysms (RVA) rupture and cardiac decompensation
We presented the rare case of a 59-year old female su ering from a high- ow RAVF of uncertain aetiology causing multiple RVAs at high risk of rupture, successfully treated by endovascular occlusion of the LRA utilizing AVP II

Summary

Introduction

Renal arteriovenous stula (RAVF) is a rare entity with a rate of incidence less than 0.04% on post-mortem histopathological examinations [1]. e most common symptoms of RAVF include abdominal bruit, gross or micro-haematuria, diastolic arterial hypertension and increased cardiac output. E most common symptoms of RAVF include abdominal bruit, gross or micro-haematuria, diastolic arterial hypertension and increased cardiac output. The decreased peripheral resistance may lead to diastolic overload and congestive cardiac failure [2, 3]. Acquired RAVF can display aneurysmal appearance and is considered to bear high risk for fatal rupture with life-threatening bleeding complications [4]. Primary renal vein aneurysms (RVA) have a low prevalence with only few cases published [5,6,7,8]. Simultaneous occurrence of an acquired RAVF and RVA has been described in rare cases [10, 11]. We report the case of a 59-year-old woman with a high- ow RAVF combined with multiple RVAs. is was successfully treated with the Amplatzer Vascular Plug (AVP) II device (Abbott Vascular, Abbott Park, IL, USA) for complete RAVF occlusion and prevention of RVA rupture

Case Presentation

Discussion

Findings

30 Collapsed

Conclusion