Simultaneous transarterial and transvenous coil embolization for a large aneurysmal-type renal arteriovenous fistula

Endovascular management of traumatic renal artery-inferior vena cava fistula in a COVID patient

A young teenage boy was referred to this tertiary care centre with a history of penetrating trauma to the flank. He had severe pain abdomen and gross haematuria on presentation. Imaging studies revealed a high flow direct fistulous communication between the renal artery and the inferior vena cava. On further work-up, the patient was also diagnosed with SARS-COV 2. Considering the young age of the patient, haemodynamic stability and the presence of a high flow arteriovenous fistula, endovascular management was opted. Diagnostic runs confirmed a high flow fistulous communication between the renal artery and the inferior vena cava. However, on account of logistic challenges at the time due to pandemic related restrictions, hardware accessibility was limited and hence simple coiling was contemplated. During the course of the procedure, the first coil which was deployed ran off via the fistulous communication into the inferior vena cava and got lodged in the right atrium. A separate venous access was obtained and the coil was retrieved with the help of a snare. The coil embolisation was next attempted again by starting distal to the pseudoaneurysm neck and proceeding proximally. In the end, successful coil embolisation of the fistula was done using slightly oversized coils.

Transvenous salvage of coil migration with intraprocedural pulmonary circulation protection and successful transvenous coil embolization for the treatment of giant high-flow renal arteriovenous fistula

Transcatheter embolization is a well-established treatment for renal arteriovenous fistula (AVF) in selected cases. Transarterial approach has been the conventional route of access of the AVF. In large arteriovenous shunts, however, transarterial approach inherits the risk of distal migration of embolization material with subsequent pulmonary embolism. We report a case of giant high-flow renal arteriovenous fistula treated with coil embolization. Arterial approach was attempted with double catheter technique, however complicated with coil mass dislodgement. We have retrieved the coil mass via transvenous route with simultaneous pulmonary circulatory protection and subsequent successful transvenous coil embolization with complete obliteration of the AVF was performed.