Giant idiopathic renal arteriovenous fistula managed by coils and amplatzer device: Case report and literature review

Figure 1 Axial contrast enhanced computed tomography image. A: Axial contrast enhanced CT image at the level of the heart shows markedly dilated RA and the RV. Note small right pleural effusion due to right ventricular failure; B: Axial contrast enhanced CTA image at the level of right kidney reveals dilated right renal artery (red curved arrow) and a peripherally calcified aneurysm (yellow arrowheads) with early enhancing dilated renal vein (straight arrows) and IVC suggestive of arteriovenous fistula. Note mild ascites due to right ventricular failure (white arrowheads); C: 3D volume rendered image from the CTA data provides an excellent demonstration of marked aneurysmal right renal artery and vein with secondary severe dilatation of the IVC and gonadal varices due to increased blood flow volume. RA: Right atrium; RV: Right ventricle; CTA: Computed tomography angiogram; IVC: Inferior vena cava.

Figure 2 Conventional catheter angiogram image. A: Conventional catheter angiogram image after using multiple coils showed persistent faint opacification of the inferior vena cava (arrows); B, C: Catheter angiogram image shows the placement of the Amplatzer vascular plug II (arrows) with successful obliteration of the fistulous communication. The proximal renal artery branches were spared.

Figure 3 Images reveal resolution of ascites and occlusion of the renal arteriovenous fistula. A: Axial CT image following successful coil occlusion of fistula reveal interval lack of opacification of right renal venous structures and resolution of ascites. Note beam hardening related streak artifacts from the embolization coils within the right kidney; B: 3D Volume rendered image using post-processing segmentation tools clearly reveals the embolization coils and non-visualization of IVC and renal venous system in this arterial phase scan suggesting occlusion of the renal arteriovenous fistula. Note residual ectatic right renal artery. CT: Computed tomography; IVC: Inferior vena cava.