Published online Nov 16, 2016. doi: 10.12998/wjcc.v4.i11.364
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
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.