Interventional radiology in the treatment of high-flow renal arteriovenous fistulas. Report of two cases.
OBJECTIVE
To describe the morphological and haemodynamic characteristics of high-flow idiopathic renal arteriovenous fistulas and the radiological treatment techniques.


METHODS
Two cases of idiopathic renal arteriovenous fistula were treated with transcatheter embolization. In the first case, the anomalous arteriovenous communication was embolized with acrylic glue through the afferent artery while the efferent vein was temporarily occluded with a balloon catheter using the "stop flow" technique. In the second case, the fistula was occluded from the arterial side using Gianturco coils and the "free flow" technique.


RESULTS
In both cases post-procedural angiography demonstrated occlusion of the fistula. A color-Doppler US examination 6 months later showed the regularization of flow parameters in the renal artery and vein. Angiographic follow-up showed occlusion of the arteriovenous fistula, regularization of the renal artery calibre and normal renal parenchymal flow.


CONCLUSIONS
Embolization is the best treatment for rare, high-flow, renal arteriovenous fistulas. The "stop flow" technique with acrylic glue is fast and economical. The "free flow" technique with coils is more expensive and complex, but just as effective.
Mansueto
Giancarlo
G
Dipartimento di Scienze Morfologico-Biomediche, Istituto di Radiologia, Policlinico G. B. Rossi, Verona, Italy. giancarlo.mansueto@univr.it
D'Onofrio
Mirko
M
Gasparini
Anna
A
Procacci
Carlo
C
D000328:Adult; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D015641:Radiography, Interventional; D012082:Renal Veins / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography