Transarterial embolisation of renal arteriovenous malformation: safety and efficacy in 24 patients with follow-up
Introduction
Renal arteriovenous malformation (AVM) is a pathological communication between the arterial and venous circulation that bypasses capillary bed. AVM could be either congenital or acquired.1 Acquired AVM, arterio-venous fistula (AVF), tend to manifest as a single linear connecting vessel, comprise 70–80% of renal arteriovenous abnormalities and usually result from trauma, biopsy, surgery, malignancy, or inflammation.2 Two types of congenital renal AVM, cirsoid and cavernous type, are described. Cirsoid AVM should fulfil certain criteria, which includes no prior history of renal injury or disease and typical angiographic findings with tortuous vascular channels between segmental or interlobar renal arteries and veins.3 Cavernous AVM shows a single dilated vessels and is less common.4
Patients with renal AVM usually present with gross haematuria or flank pain with occasional accompanying hypertension or heart failure.3, 5, 6 Renal angiography is used to confirm the presence of renal AVM and in planning treatment. To date, renal AVM has been treated by surgery, such as nephrectomy. Endovascular approaches for treating AVM are gaining popularity.7 The introduction of smaller delivery catheters and more precise delivery of embolic materials have drastically reduced the morbidity associated with this technique.1, 8, 9, 10, 11, 12 Therefore, currently, this treatment modality is becoming popular as it provides maximal preservation of functioning renal parenchyma as well as treating the disease and symptoms.
Several case reports and case series of renal artery embolisation (RAE) and ablation of renal AVM have reported successful results1, 13, 14, 15; however, there are few studies regarding the comprehensive analysis of clinical and radiological outcomes and effectiveness of multiple RAE sessions based on long-term follow-up data. The present study was undertaken to evaluate the efficacy and safety of RAE for renal AVM as well as its long-term outcomes.
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Patients
From January 2001 to December 2014, 31 RAE procedures were performed for 24 renal AVMs in 24 patients at two, separate medical institutions. A total of 24 patients, i.e., 9 men (age range, 16–71 years; mean age 43 years) and 15 women (age range, 30–69 years; mean age 47 years) were included in this study.
Clinical medical records were retrospectively reviewed for symptoms and signs of renal AVM, underlying medical status and baseline renal function, i.e., blood urea nitrogen/creatinine (BUN/Cr).
Patient characteristics
Clinical characteristics and outcomes of the 24 patients and 31 procedures are summarised in Table 1. 18 patients (75%) underwent a single session of RAE, whereas 6 patients (25%) had two or more sessions of RAE. Therefore, a total of 31 RAE procedures were performed in 24 patients. 17 patients (71%) had haematuria or flank pain, and 7 (29%) were asymptomatic. One patient had a single kidney with a past medical history of nephrectomy for renal cell carcinoma.
All patients underwent CT or
Discussion
Renal AVM is an uncommon cause of haematuria and is a diagnostic and therapeutic challenge in clinical practice. The present study revealed that single or multiple RAE sessions could be an effective and safe treatment strategy for patients with renal AVM.
The technical success rate of 65% and the overall clinical success rate of 88% seem to be comparable to those reported in previous studies.1 Primary and secondary success rates were 73.7 and 94.7%, respectively, based on a review of 19 patients
Acknowledgments
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (2014R1A2A2A01005857).
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