Intrarenal arteriovenous fistula with hypertensive cardiovascular disease: Review of the literature

Abstract

Arteriovenous fistulas of the renal vessels are of particular interest because of the ability of these lesions to produce not only the systemic effects of an arteriovenous fistula but also, theoretically, those of a Goldblatt kidney. Intrarenal arteriovenous fistula is a rare lesion. We have been able to find only eleven cases reported in the literature; six of these were congenital, four were acquired and one was of undetermined etiology. We believe our case is the twelfth recorded of intrarenal arteriovenous fistula and the third of traumatic etiology. Although arteriovenous fistulas of other systemic vessels do not produce a significant hypertension, those of the renal vessels may. Clinical opinion indicates that there may be ischemia distal to an arteriovenous fistula, and experimental evidence indicates that there is ischemia and decreased pulse pressure distal to an arteriovenous fistula. The Goldblatt phenomenon of producing hypertension by partial occlusion of the renal artery is well known. We believe that the hypertension associated with certain renal arteriovenous fistulas may be explained on the basis of the Goldblatt phenomenon resulting from the altered renal hemodynamics produced by the fistula.