Balloon-Assisted Endovascular Embolization of High-Flow Renal Arteriovenous Fistula

Abstract

High-fl ow renal arteriovenous fi stula (AVF) can lead to complications such as hematuria, hypertension, high-output cardiac failure, and renal insuf fi ciency. 1,2 A 52-year-old female patient with no prior risk factors presented with dull aching pain in right lumbar quadrant for 1 month and hematuria for 7 days. There was no history of trauma to abdomen. She was hemodynamically stable at presentation. Her hemoglobinwas 6.9 g/dL. Abdominal ultrasound showed a large anechoic cystic lesion in the right lumbar quadrant with only upper pole of right kidney being visualized and intense color fl ow within the lesion in color Doppler with low resistance biphasic waveform ( ► Fig. 1A ). Chest radio-graph was normal. Computed tomography angiography revealed a large vascular pouch in the right kidney with a large arterial feeder and dilated early draining renal vein suggestive of renal AVF with large venous pouch ( ► Fig. 1B ). Diethylenetriaminepentacetate (DTPA) scan showed severely impaired renal perfusion and cortical function in right kidney with functioning parenchyma seen exclusively at upper polar region. She was counseled for endovascular treatment as upper pole of right kidney could be preserved. Right renal artery angiogram showed high-fl ow AVF involving the right mid and lower pole with