[Post-traumatic secondary arteriovenous fistulae of the kidney and their embolization. Report of 3 cases]

Clément Darcq, Laurent Guy, Jean-Marc Garcier, Louis Boyer, Jean-Paul Boiteux
Progrès en Urologie 2002, 12 (1): 21-6

INTRODUCTION: Non-iatrogenic post-traumatic arteriovenous fistulas of the kidney raise a diagnostic and especially therapeutic problems. The authors report their experience based on 3 cases of arteriovenous fistulas treated by selective embolization during diagnostic arteriography.

MATERIALS AND METHOD: In a series of 18 patients urgently admitted to hospital for kidney trauma during 2000, 3 patients presented a secondary arteriovenous fistula diagnosed on arteriography. All patients were initially treated by surveillance in the surgical ward. The diagnosis of arteriovenous fistula was subsequently suspected following recurrence of haematuria with a moderate fall in haemoglobin in two cases, and secondary appearance of lumbar pain without anaemia in the third case. For the two patients with secondary haematuria, arteriography demonstrated an arteriovenous fistula associated with an arterio-caliceal fistula. For the last patient, Doppler ultrasound suggested the diagnosis of arteriovenous fistula, which was confirmed by the arteriography.

RESULTS: Selective embolization by "coils" and particle was performed during arteriography and ensured closure of the fistulas in every case. The postoperative course was uneventful for all three patients. With a mean follow-up of 7 months, no recurrence of the fistula has been observed. The remaining renal parenchyma is functional with preservation of renal function.

CONCLUSION: The risk of arteriovenous fistula must be kept in mind in any case of lumbar trauma. Arteriography with selective embolization allows good control of these secondary fistulas while preserving a maximum of functional renal parenchyma, and therefore appears to be the treatment of choice of this complication.

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