Indirect carotid cavernous fistula appeared after balloon embolization of direct CCF

Summary.  The authors describe a case of indirect carotid cavernous fistula (CCF) appearing five months after embolization for traumatic direct CCF, which was treated six months after the trauma. Long-term (six months) venous hypertension to the affected cavernous sinus due to direct CCF and cavernous sinus thrombosis following a balloon embolization were considered as an etiology of the de novo dural arteriovenous fistula. The recurrent symptoms of CCF are usually related to detached balloon disorder, but delayed recurrence may be caused by the de novo dural AVF, if the direct CCF was treated in the chronic state.     

获得性动-静脉瘘的介入微创治疗

目的 评价用介入微创技术治疗获得性动一静脉瘘(AVF)的安全性和疗效。方法 对10例不适宜传统外科治疗的AVF患者进行介入治疗,包括肾动-静脉瘘4例、髂动-静脉瘘3例、锁骨下动-静脉瘘3例。致病原因为穿通性损伤5例、医源性损伤3例、恶性肿瘤和小肠Crohn病各1例。就诊时临床表现有肢体肿胀-静脉显露6例、局部血管杂音10例、心脏负荷增加10例、右心功能衰竭2例、血尿4例。3例用经导管超选择性栓塞,7例用被覆膜支架置人封闭瘘口。结果 10例患者均治疗成功,治疗结束时复查血管造影显示瘘口被封闭。轻微并发症3例,无严重并发症。术后患者局部肿胀、静脉充血、心脏负荷过度等症状迅速改善,血管杂音消失;肾脏AVF患者,术后肾功能测定属于正常,其中2例肾动脉被覆膜支架置入患者同位素肾扫描显示患侧肾脏形态-功能正常。术后随访6个月至6年。3例患者分别于术后6、9、14个月死于与AVF无关的疾病;2例于术后3周、2个月因AVF复发,在原支架区再次置入一个被覆膜支架后残留瘘口闭塞;2例于术后6、8个月复查造影显示支架区存在轻度狭窄。7例患者仍然生存,未再针对AVF进行外科或介人治疗。结论 介入微创技术,包括超选择性栓塞和被覆膜支架置入术,是治疗获得性、复杂型AVF安全有效的方法。     

Arteriovenous access fistulae diminish cardiac reserve, anaerobic threshold and work capacity: A case for fistula closure in stable renal transplant recipients

Summary: A patent arteriovenous fistula (AVF) in stable renal transplant recipients may be viewed as 'insurance' against late graft failure and a return to haemodialysis. A patent AVF may, however, exert significant chronic demands on cardiac output (CO) which may in turn adversely affect the prognosis of patients already at risk of cardiac disease. Doppler echocardiography and anaerobic threshold (AT) assessment were used to measure the CO and the work capacity of nine stable renal transplant recipients > 15 months post transplantation who had patent AVF. Cardiac output fell from 6.9 ± 1.48L/min with the AVF open to 6.0 ± 0.97L/min with the AVF closed ( P < 0.002). the AT rose from 14.1 ± 5.67 with the AVF open to 16.5 ± 6.72 with the AVF closed ( P < 0.002). the work capacity to reach the AT improved from 68.7 ± 30.8 watts with the AVF open to 84.6 ± 38.0 watts with the AVF closed ( P < 0.004). This study suggests that a significant and chronic increase in left ventricular work-load accompanies a patent AVF resulting in a markedly reduced exercise efficiency. A patent AVF is ideal where graft survival is doubtful but, where long-term graft function is expected, the adverse effects of AVF patency, a chronic elevation in CO and reduced exercise capacity make a strong case for considering AVF closure. the prognostic advantage for left ventricular function may outweigh AVF preservation in stable renal transplant recipients.     

Asymptomatic intrarenal arteriovenous fistula accompanying severe renal vein dilatation detected 30 years after percutaneous renal biopsy.

We report on a patient with asymptomatic intrarenal arteriovenous fistula (AVF) accompanying severe renal vein dilatation detected 30 years after percutaneous renal biopsy. The patient was found to have microscopic hematuria. Three-dimensional computerized tomography confirmed the presence of an AVF, and arterial embolization was performed. Three-dimensional computerized tomography is very useful and effective to image the physiology of vascular lesions for the diagnosis of a renal AVF.     

Endovascular treatment of arteriovenous fistulas complicating percutaneous renal biopsy in three paediatric cases.

DESIGN: We evaluated the incidence and history of arteriovenous fistula (AVF) after kidney biopsy and assessed the use of superselective embolization for treatment. OBSERVATIONS: During the last 10 years, 896 kidney biopsies (age range of the patients: 1 month-18.6 years) have been performed in our institution under real-time ultrasonographic guidance with a 14 gauge cutting biopsy needle, and 32 of the patients had renal allografts (3.4%). We observed three cases of AVF (two in allograft kidneys, one in a native kidney) among all biopsies (0.34%), and the incidence of developing AVF after renal allograft biopsy was 6.3%. All three patients with AVF were symptomatic, and intravascular therapy was indicated. INTERVENTIONS: An angiographic study combined with endovascular treatment of the intrarenal AVF and pseudoaneurysm was performed in all three patients. Embolization was performed with bucrylate and lipiodol in two patients and with micro-coils in one. After successful embolization, all three patients became asymptomatic (in two renal bleeding stopped, in one patient with severe uncontrollable hypertension blood pressure returned to normal limits). No complications were observed secondary to the embolization procedure. CONCLUSION: The technique of superselective embolization using a coaxial catheter is an effective and safe method in the treatment of post-biopsy AVFs and pseudoaneurysm.     

Renal allograft arteriovenous fistula and large pseudoaneurysm

The patient was a 51-year-old female. Post-biopsy arteriovenous fistula (AVF) and pseudoaneurysm in a renal allograft were diagnosed 5 yr and 4 months after she received a renal transplantation. Four years after the diagnosis, interventional treatment for the AVF and pseudoaneurysm was performed because of a high risk of pseudoaneurysm rupture. Although the longitudinal diameter of the pseudoaneurysm was more than 5 cm, this AVF and pseudoaneurysm were treated successfully by a percutaneous transluminal embolization, and renal function has remained stable after embolization. A selective interventional procedure proved effective for the large pseudoaneurysm in the renal allograft. Therefore, when a transcutaneous needle biopsy of the renal allograft is performed, although there are no apparent symptoms or signs of vascular complications during the clinical course, periodical examinations such as echo-Doppler imaging should be made on the allograft.     

医源性肾动脉损伤性出血的介入诊疗

目的探讨超选择性动脉造影与栓塞治疗医源性肾动脉损伤性出血的临床价值。方法对11例肾穿刺活检或经皮肾镜取石术后大量肉眼血尿患者实施超选择性肾动脉造影与栓塞术,栓塞材料采用明胶海绵与弹簧圈。结果 11例中,假性动脉瘤2例,动-静脉瘘2例,假性动脉瘤合并动静脉瘘5例,动脉-肾盏瘘2例;损伤血管为肾脏后段、下段动脉及其叶间动脉分支,单支血管损伤10例,多支血管损伤1例。单纯采用明胶海绵栓塞4例,单纯采用弹簧圈栓塞4例,二者联合栓塞3例,其中1例为明胶海绵栓塞24h后复发尿血改用弹簧圈栓塞。栓塞后10min造影示出血征象消失,1~3天后患者血尿逐渐消失,未发生严重并发症。结论动静脉瘘为医源性肾动脉损伤的主要表现,以单发病变多见;超选择性动肾脉造影可迅速明确诊断,超选择性肾动脉栓塞微创、安全、有效,应作为治疗医源性肾动脉损伤性出血的首选方法。     

肺动静脉瘘的栓塞治疗和并发症的预防与对策

目的应用介入栓塞的方法治疗肺动静脉瘘,探讨栓塞治疗中并发症产生的应对对策。方法回顾性分析栓塞4例肺动静脉瘘诊治的临床资料。结果4例患者栓塞成功,其相应的临床症状及体征基本消失。1例多支供血的右肺动静脉瘘经2次栓塞封堵了供血动脉;1例右肺动静脉瘘栓塞中微钢圈脱落至左房,经股静脉入路行房间隔穿刺后取出。结论介入栓塞是治疗肺动静脉瘘的有效方法,操作得当可避免并发症的发生。     

Transvenous balloon-protected embolization of a scalp arteriovenous fistula using Onyx liquid embolic

Background  

Scalp arteriovenous fistulas (AVFs) are rare and potentially complex lesions that can be treated in a multimodal fashion. We present here the first successful treatment of a Stage Ib scalp AVF using a balloon-protected, retrograde transvenous embolization with the liquid embolic Onyx.     

The endovascular treatment of a renal arteriovenous fistula: Placement of a covered stent

We describe the case of a 40-year-old man with an acquired renal arteriovenous fistula (AVF) treated with endovascular placement of a homemade polytetrafluoroethylene covered Palmaz stent (Johnson & Johnson, Warren, NJ). The patient was seen with a abdominal bruit 5 years after exploratory laparotomy for multiple knife stab wounds. An abdominal computed tomographic scan showed an atrophic right kidney and enlarged right renal vein and inferior vena cava. Arteriography confirmed a 5-mm to 7-mm AVF between the right renal artery and vein. In November 1999, the patient was taken to the operating room where a Palmaz 308 polytetrafluoroethylene covered stent was placed within the renal artery at the site of the fistula. Exclusion of the fistula was confirmed with arteriogram. To our knowledge, this is one of the earliest reports and the longest follow-up of the endovascular placement of a covered stent for treatment of an acquired renal AVF. Continued application of covered stent treatment for renal AVFs should prove less expensive with improved renal preservation and, with prefabricated stent grafts, prove less cumbersome and time consuming than coil embolization.     

Brain stem ischemia from intracranial dural arteriovenous fistula: case report

BACKGROUND: Intracranial dural arteriovenous fistulas (AVFs) with spinal perimedullary venous drainage are rarely reported, but most of the patients initially have presented with myelopathy or subarachnoid hemorrhage. This is the first report of the intracranial dural AVF patient who presented with brain stem infarction. CASE DESCRIPTION: A 38-year-old woman experienced nausea and vomiting with an acute onset, followed by vertigo. Magnetic resonance imaging showed ischemic lesion in the medulla oblongata, and she was then sent to our hospital. On admission, she had nystagmus, swallowing difficulties, Homer syndrome, and right hemiparesis and hemisensory disturbance. Cerebral angiography revealed dural AVF draining into spinal perimedullary veins at the left transverse-sigmoid sinus. The patient was treated by transvenous embolization under local anesthesia. A microcatheter proceeded to the left sigmoid sinus via the internal jugular vein, and embolization of the sinus was performed using coils without complications. The patient's swallowing difficulties improved over a few days after the embolization, and one month later, there remained only a slight mild hemiparesis and hemisensory disturbance. Six months after the onset, there was no ischemic lesion in the brain stem on magnetic resonance imaging. CONCLUSIONS: In this case, we showed the possibility of brain stem infarction, caused by the intracranial dural AVF.     

High-Output Heart Failure Caused by a Huge Renal Arteriovenous Fistula After Nephrectomy: Report of a Case

Postnephrectomy renal arteriovenous fistula (AVF) with an aneurysmal lesion is a rare clinical entity that may cause high-output heart failure. In this report, we describe the case of a 68-year-old man who had undergone nephrectomy for renal tuberculosis 43 years previously, in whom an acquired large renal AVF presenting as an aneurysm caused congestive cardiac failure. We also discuss the hemodynamic, hormonogenic (human arterial natriuretic polypeptide; hANP), and radiographic findings before and after surgery for the AVF. The AVF with an aneurysmal lesion was clearly visualized by three-dimensional-computerized tomographic (CT) scanning, and proximal ligation of the renal artery was followed by an uneventful recovery. This procedure can produce good results when a fistula is too large to allow safe embolization and when excision would be hazardous due to inflammation surrounding the fistula. Received: March 1, 2000 / Accepted: November 20, 2000     

Nerve conduction changes following arteriovenous fistula construction in hemodialysis patients

Background  

Peripheral neuropathy is a common complication of chronic renal failure (CRF). Superimposed neuropathies may complicate arteriovenous fistulas (AVF) construction. The aim of this study was to evaluate the effect of AVF construction on nerve conduction.     

Dural arteriovenous fistula involving the superior sagittal sinus following sinus thrombosis--case report

A 57-year-old woman presented with a dural arteriovenous fistula (AVF) involving the superior sagittal sinus (SSS) based upon serial radiological examinations. Her chief complaints were headache and vomiting. Cerebral angiography and magnetic resonance (MR) venography revealed the sinus thrombosis involving the SSS, the bilateral transverse sinuses (TSs), and the right sigmoid sinus. Her symptoms disappeared after anticoagulant therapy. Follow-up MR venography revealed almost complete recanalization of the occluded sinuses, followed by restenosis of the SSS and the left TS and occlusion of the right TS without symptoms. She developed transient right hemiparesis 13 months after the initial onset. Cerebral angiography revealed a dural AVF involving the SSS with cortical reflux into the left frontoparietal region. The dural AVF was occluded by transarterial and transvenous embolization. Her symptom disappeared during the follow-up period.     

Beneficial cardiovascular remodeling following arterio‐venous fistula ligation post‐renal transplantation: a longitudinal magnetic resonance imaging study

Despite improvements in survival following renal transplantation, high rates of cardiovascular morbidity and mortality remain. Persistence of arterio‐venous fistulae (AVF) may contribute to maladaptive cardiovascular remodeling and poor health outcomes in this cohort. Utilizing recent advances in cardiovascular magnetic resonance imaging (CMR), we prospectively evaluated alterations in cardiac and vascular structure and function six months after elective ligation of AVF, following stable, successful renal transplantation. Eighteen subjects underwent CMR evaluation of cardiac structure and function, aortic distensibility and endothelial function prior to AVF ligation and at six months. At follow‐up, while left ventricular ejection fraction was unchanged, mean cardiac output decreased by 15.6% (9.6 ± 2.9 L/min vs. 8.1 ± 2.3 L/min, p = 0.004) and left ventricular mass had regressed by 10% (166 ± 56 g vs. 149 ± 51 g, p = 0.0001). Significant improvements were also noted in right ventricular and biatrial structure and function. Aortic distensibility was unchanged at follow‐up, but endothelial dependent vasodilatation had improved (2.5 ± 6.5% vs. 8.0 ± 5.9%, p = 0.04). Elective AVF ligation following successful renal transplantation is associated with improvements in left ventricular mass, right ventricular, and biatrial structure and function. Further randomized studies are warranted to determine the potential clinical improvement following AVF ligation in this cohort.     

Renal arteriovenous fistula: a case report

Congenital arteriovenous fistula(AVF) of the kidney is a rare condition. We report a case of renal AVF with chief complaints of macroscopic hematuria, and treated with transcatheter arterial embolization (TAE) using coils. The patient was diagnosed as having left renal AVF by Color Doppler ultrasound. The signs and symptoms disappeared after embolization. The clinical course of a case is reported and the literature is reviewed. Color Doppler ultrasound is required to give a definite diagnosis of renal AVF.     

Retarded hand growth due to a hemodialysis fistula in a young girl

Long-term presence of an arteriovenous hemodialysis fistula (AVF) may lead to alterations in hand perfusion. In the case reported here, a 14-year-old girl developed pain associated with hand ischemia 5 years after a successful kidney transplantation. At age 8 years, she required a period of hemodialysis using an autogenous left upper arm AVF. Compared to the healthy right hand, a smaller ischemic left hand was observed in the presence of a patent AVF. Access flow was 1400 ml/min. Seldinger angiography demonstrated a stenotic brachial artery, and duplex measurements indicated a reversed blood flow in the radial artery. AVF ligation abolished the ischemic symptoms. Distal hypotension due to an impaired arterial inflow combined with a low resistance elbow AVF may result in chronic hypoperfusion of acral portions of the extremity and growth retardation. Access ligation is advised in children with an optimal renal transplant function and a patent elbow AVF suffering from lowered distal tissue perfusion.     

Delayed presentation of arteriovenous fistula and pseudoaneurysms in a renal transplant patient 10 years after percutaneous allograft biopsy

A 51-year-old man was admitted with microscopic hematuria at 10 years after living donor renal transplantation. In order to distinguish between acute tubular necrosis and acute rejection, a graft biopsy was performed under ultrasound guidance at 1 month posttransplantation. Doppler sonography revealed 3 pulsatile cystic masses and an arteriovenous fistula (AVF) in the lower kidney pole. Selective transplant renal angiography revealed 3 pseudoaneurysms with an AVF supplied by a lobular artery in the lower pole. The diagnosis was AVF with pseudoaneurysm, which developed secondary to percutaneous renal allograft biopsy. Interventional treatment was performed because of the high risk for pseudoaneurysm rupture. The AVF and pseudoaneurysms were treated successfully by percutaneous transluminal embolization; renal function remained stable after embolization.