Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment

Zotikov A.E.¹, Adyrkhaev Z.A.^1,2, Teplov A.A.¹, Gritskevich A.A.¹, Ivandaev A.S.¹, Tsygankov V.N.¹, Timina I.E.¹, Stepanova Yu.A.¹, Askerova A.N.¹, Shvydko V.S.³, Karmazanovsky G.G.¹, Pokrovsky A.V.¹

1) Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health,
2) Chair of Angiology, Vascular and Roentgenovascular Surgery, Russian Medical Academy of Postgraduate Education of the RF Ministry of Public Health,
3) Chief Clinical Hospital of the Ministry of Internal Affairs of the Russian Federation, Moscow, Russia

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world’s first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.

KEY WORDS: renal arteriovenous malformation, intraparenchymatous arteriovenous aneurysm, nephrectomy.

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