Complex Arteriovenous Malformation in a Kidney with Multiple Renal Arteries: A Case Report

Abstract

The abnormal communications between arteries and veins outside the capillary level are called Arteriovenous Malformation (AVM). A 25-year-old known hypertensive on irregular medications, presented with acute stroke (Computed Tomography (CT) brain revealed left putamen haemorrhage). On evaluation, all routine investigations were normal except for microscopic haematuria. Ultrasound (USG) KUB showed right AVM and on further evaluation with 320 slice Contrast Enhanced Computed Tomography (CECT) abdomen with angiogram and 3D reconstruction revealed right kidney supplied by three renal arteries. The second renal artery was dilated (1.1 cm diameter) and communicates directly with aneurysmally dilated right renal vein (2.9 cm diameter). Digital Subtraction Angiography (DSA) with angioembolisation was done four days’ postadmission. Large second renal artery with a direct Arteriovenous Fistula (AVF) draining into the renal vein with aneurysmal venous sacs was occluded with 16 mm, 12 mm and 10 mm coils. Complete obliteration of fistula was confirmed. Then the inferior most third renal artery was accessed and angiogram revealed RAVM with multiple feeders shunting into the venous sacs and it was occluded with 40% glue. Postoperative day one USG showed thrombosed venous aneurysmal sacs and occlusion of the arterial fistulae. He was discharged at four weeks with antihypertensive and antiseizure medications. During the follow-up there was no loss in the function of the kidney and micro or macroscopic haematuria was not detected.

Keywords

• aneurysm
• arteriovenous fistula
• cirsoid
• digital subtraction angiography
• embolisation