Endovascular Treatment of a Renal Arteriovenous Fistula

Introduction: Renal arteriovenous fistulas (RAVF) are a rare pathology, with low incidente (0.04%). However, in the last years, due to the increase of diagnostic and therapeutic invasive procedures and the improvement of image Studies, its diagnosis has risen. RAVF can be congenital or adquirid, being those traumatical the most frequently found (more than 70% of all). Generally asymptomatic, they can produce hypertension, hematuria, cardiac insufficiency and even rupture. Methods: We present the case of a 69 years old male, with medical history of hypertension, diabetes, dyslipidemia and congenital factor VII deficiency. He attends our Hospital with an episode of thoracic pain, being diagnosed of acute myocardial infarction. A coronary cateterism is made and pharmacoactive stent is placed. After the procedure, double antiagregation is instaured. During postoperative stay the patient develops severe pulmonary hypertension with cardiac insufficiency. Diagnostic image studios show findings compatible with RAFV . Results: We decide to perform an arteriographic study, where the presence of RAVF is confirmed (FIG 2). We proceed to place a 18X14mm Amplatzer Plug II occlusion device as therapeutic treatment, with good angiographic result No postoperative complications were noticed, with the patient being discharged from the hospital within 24 hours. Control angio-TC made 1 month after the intervention showed no signs of RAVF . Pulmonary hypertension was solved. Conclusion: Historically, open Surgery has been the elective treatment. However, in the last years the development of endovascular tecniches has shown a less invasive alterntive, with great therapeutic succes and low morbi-mortality