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Suzuki T, Yamaguchi H, Kojima M, Kariyasu T, Nakamoto R, Nishikawa M, Machida H, Shoko T. Renal arteriovenous malformation treated using glue embolization under inflow and outflow control by balloon occlusion. Radiol Case Rep 2024; 19:2035-2038. [PMID: 38449487 PMCID: PMC10917633 DOI: 10.1016/j.radcr.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
A 45-year-old female presented with gross hematuria. Right renal arteriovenous malformation on abdominal contrast-enhanced computed tomography necessitated urgent transcatheter arterial embolization. Right renal digital subtraction angiography revealed a single tortuous and dilated vessel converging to an aneurysmal dilated vein. To selectively embolize the malformation, we closed the arterial side with a microballoon and attempted glue embolization; filling occurred unexpectedly early, and another balloon on the vein side helped control the renal vein blood flow. Glue embolization was performed without adverse events. Glue embolization for high-flow arteriovenous malformation under balloon occlusion-mediated inflow and outflow control can effectively and safely embolize complete target vessels.
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Affiliation(s)
- Tensei Suzuki
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Hidenori Yamaguchi
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Mitsuaki Kojima
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Toshiya Kariyasu
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Raira Nakamoto
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Makiko Nishikawa
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Haruhiko Machida
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Tomohisa Shoko
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Hayashi H, Kiyosue H, Tamura Y, Ueda H, Yonemura M, Sasaki G, Hokamura M, Ishiuchi S, Kanaya H, Uetani H, Oda S, Kawanaka K, Hirai T. Transarterial Embolization of Renal Arteriovenous Malformations: Treatment Outcomes According to Angiographic Classification. J Vasc Interv Radiol 2024:S1051-0443(24)00246-X. [PMID: 38537737 DOI: 10.1016/j.jvir.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 05/20/2024] Open
Abstract
PURPOSE To assess the different adjunctive catheter techniques required to achieve complete occlusion of renal arteriovenous malformations (rAVMs) of different angioarchitectural types. MATERIALS AND METHODS Overall, data on 18 patients with rAVM (Type 1, n = 7; Type 2, n = 2; Type 3, n = 9; mean age, 53.8 years) who underwent 25 procedures between 2011 and 2022 were reviewed. The clinical presentations, endovascular techniques, arteriovenous malformation (AVM) occlusion rate, adverse events (including the incidence of renal infarction), and clinical symptoms and outcomes (including recurrence/increase of AVM) were analyzed according to the Cho-Do angioarchitectural classification. Posttreatment renal infarction was classified as no infarction, small infarction (<12.5%), medium infarction (12.5%-25%), and large infarction (>25%) using contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS Hematuria and heart failure were presenting symptoms in 10 and 2 patients, respectively. The embolic materials used were as follows: Type 1 rAVM, coils alone or with n-butyl-2-cyanoacrylate (nBCA); Type 2 rAVM, nBCA alone or with coils; and Type 3 rAVMs, nBCA alone. Fourteen patients underwent adjunctive catheter techniques, including flow control with a balloon catheter and multiple microcatheter placement, alone or in combination. Immediate postprocedural angiography revealed complete occlusion in 15 patients (83%) and marked regression of rAVM in 3 (17%). Small asymptomatic renal infarctions were observed in 6 patients with Type 3 rAVMs without any decrease in renal function. No major adverse events were observed. All symptomatic patients experienced symptom resolution. Recurrence/increase of rAVM was not observed during the mean 32-month follow-up period (range, 2-120 months). CONCLUSIONS Transarterial embolization using adjunctive catheter techniques according to angioarchitectural types can be an effective treatment for rAVMs.
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Affiliation(s)
- Hidetaka Hayashi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Hiro Kiyosue
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshitaka Tamura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Ueda
- Department of Diagnostic Radiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mari Yonemura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Goh Sasaki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masamichi Hokamura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Soichiro Ishiuchi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Kanaya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kawanaka
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Wang X, Zhao Z. Renal arteriovenous malformation causing hematuria: Case report and review of the literature. Medicine (Baltimore) 2023; 102:e34547. [PMID: 37653758 PMCID: PMC10470693 DOI: 10.1097/md.0000000000034547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/12/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE Renal arteriovenous malformations are rare vascular morphological anomalies that can be classified as congenital, idiopathic and acquired, of which congenital renal arteriovenous malformations are the most common. This disease is a rare cause of hematuria. In this case report, we report the diagnosis and treatment of a patient with renal arteriovenous malformation. We also review the symptoms, diagnosis and treatment of renal arteriovenous malformations in the published literature. PATIENT CONCERNS A 35-year-old female patient presented to a local hospital with right-sided lumbar abdominal pain with hematuria for 2 days. Physical examination showed percussion pain in the right renal area. Laboratory tests such as routine blood and blood biochemistry did not show any significant abnormalities when the patient entered the hospital. Considering the patient's medical history, a urological computed tomography scan showed blood accumulation in the right renal pelvis, upper middle ureter and bladder. Subsequently, routine blood tests showed that the patient's red blood cells and hemoglobin continued to decrease. An emergency renal arteriogram was performed, which showed a tortuous right upper renal pole branch artery and multiple thickened veins communicating with it. DIAGNOSIS This patient was diagnosed with cirsoid renal arteriovenous malformation. INTERVENTIONS Renal artery embolization was performed immediately after the renal arteriogram was performed on the patient. OUTCOMES On review of the angiogram, the tortuous right upper renal pole branch artery was found to be obstructed, and the thickened vein disappeared, and the renal vein was normally visualized in due course. On the third postoperative day, the patient was free of hematuria. Physical examination showed no percussion pain in the renal area. The patient healed and was discharged. A 1-year follow-up was performed and the patient gave feedback that she no longer had symptoms such as back pain and hematuria in her daily life. LESSONS This case illustrates that early use of vascular interventions is an important method for the diagnosis and treatment of cirsoid renal arteriovenous malformations.
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Affiliation(s)
- Xin Wang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Zhankui Zhao
- Department of Urology, Affiliated Hospital of Jining Medical University, Jining, China
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Gong M, He X, Zhao B, Kong J, Gu J, Su H. Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubran 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Conditions. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 03/13/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
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Mahdjoub E, Serhal A, Males L, Tligui M, Hermieu JF, Khalil A. Ethylene Vinyl Alcohol Copolymer Embolization for Acute Renal Hemorrhage: Initial Experience in 24 Cases. AJR Am J Roentgenol 2020; 214:465-71. [PMID: 31714850 DOI: 10.2214/AJR.19.21508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the efficacy and safety of ethylene vinyl alcohol (EVOH) copolymer (Onyx, Medtronic) for embolization for acute renal hemorrhage. MATERIALS AND METHODS. Between October 2006 and June 2018, 24 consecutive patients were treated by embolization with EVOH copolymer for acute renal hemorrhage at Hôpital Bichat-Claude-Bernard. CT angiography was performed in all patients before treatment. Technical success was defined as the complete occlusion of the bleeding artery on final renal angiogram. Clinical success was defined as the absence of rebleeding after embolization. Complications mid procedure, infarcted renal area on final angiogram, and renal function 1 week after embolization were retrospectively analyzed. RESULTS. Active bleeding was observed in all cases. The causes of acute renal hemorrhage were iatrogenic in 12 patients, vascular malformation in four patients, renal tumor in four patients, and unknown in four patients. EVOH copolymer was the sole embolic agent used in 16 patients. In eight patients, EVOH copolymer was used after persistent bleeding after embolization with coils. Technical and clinical success rates were 100%. No patient required surgery or new embolization during a mean follow-up period of 35 months (range, 6-86 months). No serious complications were attributable to EVOH copolymer. The mean infarcted renal area was 10% (range, 5-30%). Renal function, available for 16 (67%) patients, was not altered 1 week after embolization. CONCLUSION. EVOH copolymer is safe and effective for embolization of acute renal hemorrhage, either as a first-line embolic agent or after failure of coil embolization.
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Lee SY, Do YS, Kim CW, Park KB, Kim YH, Cho YJ. Efficacy and Safety of Transvenous Embolization of Type II Renal Arteriovenous Malformations with Coils. J Vasc Interv Radiol 2019; 30:807-12. [PMID: 30930002 DOI: 10.1016/j.jvir.2018.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of transvenous coil embolization of the venous sac for type II renal arteriovenous malformation (AVM). MATERIALS AND METHODS A retrospective review was conducted of 8 patients (5 women and 3 men; mean age, 57 years; age range, 41-69 years) who underwent transvenous coil embolization for type II congenital renal AVM at 5 different hospitals between 2012 and 2018. Additional intra-arterial ethanol injection was performed if shunt flow persisted after venous sac coiling. Technical success was defined as complete occlusion of shunt flow with coil embolization. Clinical success was defined as no symptom recurrence during the follow-up period. The renal parenchymal infarction rate was measured on computed tomography (CT), and procedure-related complications were reviewed. RESULTS Nine sessions of embolization were performed for 8 patients. The mean venous sac size was 24 mm (range, 10-39 mm), and a mean of 14 micro and/or micro-detachable coils (range, 3-50) were used. The technical success rate was 88% (7 of 8) using coil embolization. One patient (12%) required additional ethanol injection to complete occlusion of the shunt flow and had a less than 10% parenchymal infarction on follow-up CT. No procedure-related complications or recurrences occurred during a mean clinical follow-up period of 20.8 months (range, 4.7-76.6 months). CONCLUSIONS Transvenous coil embolization of type II renal AVM showed an 88% technical success rate. One patient (12%) showed less than 10% renal parenchymal infarction after additional ethanol injection. No additional complications or recurrences occurred during the follow-up period.
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Abstract
BACKGROUND Congenital renal vascular anomalies have been classified into 3 categories: cirsoid, angiomatous, and aneurysmal. These classifications are based on the size, location, and number of vessels involved. Aneurysmal malformations, such as the one reported here, have a single (and dilated) feeding and draining vessel. The prevalence of renal AVMs is estimated at less than 0.04%, making them rare causes of secondary hypertension. CASE REPORT A 29-year-old white woman was seen in the hypertension clinic as a referral from high-risk obstetric clinic for management of hypertension (HTN). A secondary hypertension workup with Doppler waveforms of the renal arteries revealed prominent diastolic flow in the left compared to the right. For confirmation, an MRA was done, which showed a large left renal upper-pole arteriovenous malformation (AVM) with associated vascular shunting and early opacification of the left renal vein. This congenital AVM was identified as the cause of her hypertension. Angiography and coil embolization were performed. The patient's BP normalized within a few days and she was taken off her antihypertensive medications. CONCLUSIONS This case illustrates that a careful review of duplex waveforms beyond just peak velocity and ratios is important to identify uncommon pathologies. This is important, as renal AVMs respond well to embolization, with resolution of hypertension in 59% of patients treated.
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Affiliation(s)
- Nicholas Isom
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Reza Masoomi
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA
| | - Adam Alli
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kamal Gupta
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA
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