You are here: Urology Textbook > Kidneys > Arteriovenous malformations

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, iatrogen 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).

Epidemiology

Congenital renal arteriovenous malformations are rare, with a prevalence of 40 per 100,000 reported in an autopsy study. Acquired renal arteriovenous fistulas arise predominantly as iatrogenic lesions after renal biopsy or urologic interventions. After partial nephrectomy or percutaneous nephrolithotomy, the overall incidence of iatrogenic vascular lesions, most commonly pseudoaneurysms and less frequently arteriovenous fistulas, is approximately 1–2%.

Signs and Symptoms

• Loud bruit
• Arterial hypertension
• Left ventricular hypertrophy and left ventricular failure
• Hematuria
• Flank pain
• Asymptomatic incidental findings are possible.

Diagnostic Workup

Laboratory studies (complete blood count, serum creatinine, urinalysis, and coagulation testing), renal ultrasonography with Doppler, CT angiography, or MR angiography. Digital subtraction angiography is the diagnostic gold standard because it precisely delineates morphology and hemodynamics while simultaneously allowing endovascular treatment.

Treatment of renal AV-fistula

In small, asymptomatic, iatrogenic arteriovenous fistulas, an initial conservative approach with clinical and sonographic follow-up is reasonable. Endovascular intervention is the treatment of first choice, including selective embolization, coil occlusion, or placement of a covered stent. Open surgical intervention is required in difficult cases and in the presence of complications. Partial nephrectomy should be pursued when renal function is adequate. (Laparoscopic) nephrectomy is necessary in the absence of renal function or when large arteriovenous fistulas cannot be controlled without nephrectomy. When present, medical treatment of hypertension and heart failure is essential before surgical intervention.

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

Urology-Textbook.com – Choose the Ad-Free, Professional Resource

This website is designed for physicians and medical professionals. It presents diseases of the genital organs through detailed text and images. Some content may not be suitable for children or sensitive readers. Many illustrations are available exclusively to Steady members. Are you a physician and interested in supporting this project? Join Steady to unlock full access to all images and enjoy an ad-free experience. Try it free for 7 days—no obligation.

New release: The first edition of the Urology Textbook as an e-book—ideal for offline reading and quick reference. With over 1300 pages and hundreds of illustrations, it’s the perfect companion for residents and medical students. After your 7-day trial has ended, you will receive a download link for your exclusive e-book.