Iatrogenic renal arteriovenous fistula treated with coil embolization
Persistent hematuria after percutaneous lithotripsy and nephrostomy.
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An arteriovenous fistula from a proximal renal artery bifurcation:
1. Hand injection demonstrates a proximal renal artery bifurcation and a blush at the middle third of the right kidney.
2. Super selective contrast injection demonstrates an arteriovenous fistula, arising from a branch of the accessory renal artery. Note the venous outflow earlier than the parenchymatous phase.
3. Selective right renal artery angiography post coil embolization. Note the resolution of the AV fistula without compromising the renal parenchyma.
Renal AV fistulas are rare complications from percutaneous lithotripsy, occurring in about 1-4% of cases.
This patient had percutaneous lithotripsy treatment for of coraliform calculi with nephrostomy tube placement. After the nephrostomy tube was withdrawn, there was severe hematuria requiring packed red blood cells transfusion. After embolization, the bleeding ceased and the patient was discharged.
- 1. Dagli, Mandeep, and Parvati Ramchandani. “Percutaneous Nephrostomy: Technical Aspects and Indications.” Seminars in Interventional Radiology 28.4 (2011): 424–437. PMC. Web. 20 Aug. 2015.