Nagpal P, Bathla G, Saboo SS, Khandelwal A, Goyal A, Rybicki FJ, Steigner ML. Giant idiopathic renal arteriovenous fistula managed by coils and amplatzer device: Case report and literature review. World J Clin Cases 2016; 4(11): 364-368 [PMID: 27900325 DOI: 10.12998/wjcc.v4.i11.364]
Corresponding Author of This Article
Girish Bathla, MBBS, FRCR, Department of Radiology, University of Iowa Hospital and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States. girish-bathla@uiowa.edu
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 16, 2016; 4(11): 364-368 Published online Nov 16, 2016. doi: 10.12998/wjcc.v4.i11.364
Giant idiopathic renal arteriovenous fistula managed by coils and amplatzer device: Case report and literature review
Prashant Nagpal, Girish Bathla, Sachin S Saboo, Ashish Khandelwal, Abhishek Goyal, Frank J Rybicki, Michael L Steigner
Prashant Nagpal, Girish Bathla, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
Prashant Nagpal, Sachin S Saboo, Ashish Khandelwal, Frank J Rybicki, Michael L Steigner, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Sachin S Saboo, Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX 75235, United States
Abhishek Goyal, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States
Author contributions: Nagpal P, Bathla G and Goyal A designed the report and helped with writing the manuscript; Saboo SS and Khandelwal A helped with radiological image interpretations and preparation of the images; Rybicki FJ and Steigner ML participated in review and revision of the manuscript.
Institutional review board statement: Our institution does not need patient consent to publish a single case. The patient provided informed written consent prior to the treatment described in the report.
Informed consent statement: Our institution does not need patient consent to publish a single case. The patient provided informed written consent prior to the treatment described in the report.
Conflict-of-interest statement: All of the authors report no relationships that could be construed as a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Girish Bathla, MBBS, FRCR, Department of Radiology, University of Iowa Hospital and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States. girish-bathla@uiowa.edu
Telephone: +1-319-4001511
Received: March 11, 2016 Peer-review started: March 14, 2016 First decision: March 25, 2016 Revised: July 20, 2016 Accepted: August 30, 2016 Article in press: August 31, 2016 Published online: November 16, 2016 Processing time: 247 Days and 12.5 Hours
Abstract
An idiopathic renal arteriovenous (AV) fistula is a rare malformation of the kidney that may present insidiously with heart failure or hematuria. The treatment may be challenging due to large fistula size that may limit endovascular management. The authors report a case of an 85-year-old Caucasian woman who presented with acute heart failure and was found to have a right renal AV fistula. Since she had no prior history of renal intervention or trauma, a diagnosis of idiopathic renal AV fistula was made. She was managed by endoluminal occlusion using multiple stainless steel coils and Amplatzer vascular plug II device. The follow-up computed tomography showed complete occlusion of the fistula. This report highlights the late presentation of this rare disease and presents the utility of the combination of coils and Amplatzer device for management of a large fistula. It also reiterates that even if large, these fistulas can be managed by endovascular occlusion.
Core tip: Idiopathic renal arteriovenous fistula is rare but may present in middle-aged to elderly population with heart failure or hematuria. It is more common in right kidney and typically there is a single communication with the renal vein. Since these can have a very high-flow, the management can be challenging, but is typically done by nephrectomy or endovascular occlusion. With advances in endovascular techniques, it has become the preferred management option. If conventional embolizing materials do not obtain appropriate closure, Amplatzer vascular plug II may be used to reinforce the occlusion of the feeding artery.
