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Renal Arteriovenous Fistula and AV Malformations

Definitions

Renal arteriovenous fistula:

An arteriovenous fistula is a single pathological communication between the renal artery and vein, most often due to trauma or degeneration.

Renal arteriovenous malformation:

An arteriovenous malformation consists of multiple pathological communications between artery and vein with a vascular nidus that bypass the capillary bed. Arteriovenous malformations are most often congenital (Cura et al., 2010).

Etiology of Renal AV Fistula

• Congenital (25%): varicose-like multiple connections between artery and vein, most common at the upper pole of the kidney, female : male = 3:1
• Renal trauma
• Iatrogenic causes: renal biopsy, kidney surgery
• Inflammation
• Venous erosion of a renal artery aneurysm

Signs and Symptoms

• Loud bruit
• Arterial hypertension
• Left ventricular hypertrophy and left ventricular failure
• Hematuria
• Flank pain

Diagnostic Workup

• Renal ultrasound with Doppler sonography
• CT-abdomen
• Angiography
• Kidney scintigraphy to assess renal function

Treatment of renal AV-fistula

Endovascular therapy is the treatment of first choice: selective embolization, occlusion with coils or placement of a stent. Open surgery is reserved for difficult cases. Partial nephrectomy should be attempted in good renal function. (Laparoscopic) nephrectomy is necessary for the absence of renal function or if large AV fistulas cannot be controlled. If present, medical treatment of hypertension and cardiac failure are paramount.

References

Cura, M.; Elmerhi, F.; Suri, R.; Bugnone, A. & Dalsaso, T. Vascular malformations and arteriovenous fistulas of the kidney.
Acta Radiol, 2010, 51, 144-149.

  Deutsche Version: Arteriovenöse Fistel der Nierengefäße