Outcomes of Six Patients Who were Treated with Selective Embolisation Due to Arteriovenous Fistula Following Percutaneous Nephrolithotomy

Abstract

Objective: Arteriovenous fistula (AVF) is a rare yet serious complication of percutaneous nephrolithotomy (PCNL). The aim of this study was to investigate the preoperative characteristics and postoperative outcomes of patients treated with single-session selective embolisation following a diagnosis of AVF after PCNL. Methods: Data from 1,200 patients who underwent PCNL in our department between January 2008 and December 2014 were retrospectively reviewed. Overall, six patients who experienced delayed haematuria and were diagnosed with AVF formation were included. Patient characteristics, stone burden, PCNL procedure, and perioperative and postoperative parameters were evaluated. Results: Six patients with a mean age of 52 years (range: 42-57) were admitted to hospital with delayed intermittent haematuria following PCNL. All pre-PCNL stones in these patients were staghorn in type. Four patients (66%) had multiple access. Three patients needed blood transfusion due to development of hypotension. Following the diagnosis of AVF via angiography, all six patients were treated with selective embolisation during the same session. No additional treatment was required and no complications detected. Conclusion: AVF formation is one of the causes of delayed haemorrhage after PCNL. Multiple accesses, staghorn stones, and upper calyx entry increase the risk of bleeding and AVF formation. Patients with risk factors should be informed about delayed bleeding and possible complications of PCNL.