Endovascular Treatment of a Traumatic Renal Arteriovenous Fistula

BACKGROUND: Renal arteriovenoous fistula (AVF) may result in high output cardiac failure and systemic hemodynamic compromise. We report a unique endovascular approach to this complex problem.
METHODS: A 63 year male presented with congestive heart failure 20 years after an abdominal GSW and nephrectomy. Physical exam detected an abdominal bruit in the right upper quadrant a thrill was noted on gentle palpation. Ultrasound revelaed a dilated inferior vena cava and a renal AVF.
RESULTS: After placement of pulmonary artery catheter, selective right renal arteriogram was performed from a femoral approach. A large AVF between the renal artery and vein was identified. Embolization was accomplished succesfully, as demonstrated by follow up arteriogram, with placement of 22mm Amplatzer nintinol plug followed by a more proximal 16 mm plug. An immediate rise in systemic resistance was noted after occlusion of the AVF. Successful repair was confirmed by ultrasound at 6 weeks.
CONCLUSIONS: Large renal AVF can lead to significant hemodynamic disturbances. Endovascular therapy with plug embolization may provide a safe and effective alternative to open repair.