Abstract
BackgroundWe report the use of a 4 mm vascular Amplatzer for the occlusion of a renal arterovenous fistula between the renal artery, at the hylum trifurcation point, and an aneurismatic vein draining into the main renal vein, where there was no possibility to use any other device from the venous side, because of the diameter and the high flow, neither from the arterious side without sacrificing lobar branches. The device was implanted at the exact point of communication, like a patent foramen ovale occluder, with the distal disc into the artery lumen and the other two proximal discs into the venous side.Case presentationA 34-years-old Caucasian woman suffered several episodes of paroxysmal supraventricular tachycardia associated with dyspnoea, after the onset of post-pregnancy hypertension. She underwent CTA, spectral Doppler sonography and angiography which showed a renal arteriovenous fistula (RAVF) between the renal artery, at the hylum trifurcation point, and an extremely ectatic vein draining into the main renal vein of the right kidney.With both arterial and venous access, the RAVF was selectively embolized using a 4 × 6 mm Amplatzer Vascular Plug II, released into the communication between artery and vein ensuring the patency of vessels involved.The RAVF was almost completely excluded and the hemodynamic effects associated were also corrected.ConclusionsThe use of this device, though in an alternative way, allowed the exclusion of the high flow A-V fistula without sacrificing any parent renal vessel and preserving the renal function.
Highlights
We report the use of a 4 mm vascular Amplatzer for the occlusion of a renal arterovenous fistula between the renal artery, at the hylum trifurcation point, and an aneurismatic vein draining into the main renal vein, where there was no possibility to use any other device from the venous side, because of the diameter and the high flow, neither from the arterious side without sacrificing lobar branches
We present the case of a woman with High output cardiac state (HOS) caused by a renal arteriovenous fistula (RAVF) treated with percutaneous embolization using a 4 mm Amplatzer Vascular Plug II
In this patient the arteriovenous communication was between the renal artery, at the hylum trifurcation point, and an aneurismatic vein draining into the main renal vein, where there was no possibility to use any other device from the venous side, because of the diameter and the high flow, neither from the arterious side without sacrificing lobar branches
Summary
The placement of a covered stent in the arterial lumen was considered, but not feasible without sacrificing three arterial branches, due to their origin close to the arteriovenous communication point. In particular Perkov D et al (Perkov et al, 2013) used a 12 mm Amplatzer Vascular Plug II released in the main artery feeding straight the arteriovenous fistula of the right kidney, while Kayser O et al (Kayser & Schafer, 2013) deployed a 7 mm Amplatzer Vascular plug IV within the venous segment of the AVF and they occluded the right renal artery with a 16 mm Amplatzer Vascular plug II. We released a 4 mm AVP II transversely to the artery, across the fistula point, with just one disk inside arterial lumen and the other two disks into the venous ectasia, like a patent foramen ovale (PFO) occluder.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
