Embolization of Giant Post-Traumatic Arteriovenous Renal Fistula using the Penumbra Occlusion Device

Abstract

A 48 year-old-man with history of abdominal trauma came to the emergency department reporting back pain. The patient underwent abdominal ultrasonography for lumbar pain with detection of voluminous vascular alteration. Immediately, computed tomography angiography (CTA) was performed that demonstrated renal artero-venous fistula with aneurysmatic dilatation. After multidisciplinary discussion, an endovascular treatment was decided upon. Angiography confirmed a high-flow renal AV fistula, and the aneurysmatic dilatation and very tortuous renal artery. The complex anatomic situation was resolved with neuro derivated embolic metallic spirals. Complete exclusion of the fistula and aneurysm was obtained. CTA after the endovascular procedure demonstrated that renal perfusion was completely preserved.