title: Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture.
abstract: Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Miyuki
authors.initials: M
authors.lastname: Maruno
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Hiro
authors.initials: H
authors.lastname: Kiyosue
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tanoue
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Norio
authors.initials: N
authors.lastname: Hongo
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Shunro
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Sagara
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.).
authors.forename: Junji
authors.initials: J
authors.lastname: Kashiwagi
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology; D015901:Angiography, Digital Subtraction / Q000379:methods; D001164:Arteriovenous Fistula / Q000145:classification / Q000000981:diagnostic imaging* / Q000628:therapy; D001706:Biopsy / Q000009:adverse effects; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods; D061330:Multidetector Computed Tomography / Q000379:methods; D012077:Renal Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000293:injuries; D012082:Renal Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000293:injuries; D018615:Ultrasonography, Doppler, Color / Q000379:methods
chemical_list: D004659:Enbucrilate