Embolisation of a high – flow renal arteriovenous fistula with the use of simultaneous transvenous and transarterial approach and balloon-assisted coil embolization

Abstract

Renal arteriovenous fistula (RAVF) is a rare vascular malformation, which can be asymptomatic or may cause hemorrhage, hypokalaemic hypertension, heart failure and hematuria. Endovascular embolization is a minimally invasive method which can preserve renal parenchyma. In our case, balloon assisted coil embolization with simultaneous transvenous and transarterial approach was used. A remodelling balloon, which is routinely used in neurovascular procedures, was chosen in order to eliminate the risk of coil migration and preserve feeding artery and renal parenchyma. We present a case of successful balloon – assisted coil embolization of a high flow renal arteriovenous fistula in a 25-year-old male patient via simultaneous transarterial and transvenous approach with preservation of the feeding artery. Endovascular embolisation is a safe and effective treatment of RAVFs with low risk of complications. Simultaneous transarterial and transvenous coil deployment with the use of a flow control balloon catheter can eliminate the risk of coil migration and coil protrusion into the parent artery with permanent RAVF occlusion and renal parenchyma preservation.