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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 531-532
Delayed presentation of traumatic renal AV fistula managed by coil embolization

Department of Urology, Christian Medical College, Vellore, India

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Date of Web Publication26-Apr-2010

How to cite this article:
Banerji JS, Aswathaman K, Mani SE. Delayed presentation of traumatic renal AV fistula managed by coil embolization. Saudi J Kidney Dis Transpl 2010;21:531-2

How to cite this URL:
Banerji JS, Aswathaman K, Mani SE. Delayed presentation of traumatic renal AV fistula managed by coil embolization. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Nov 27];21:531-2. Available from: https://www.sjkdt.org/text.asp?2010/21/3/531/62707
To the Editor,

Arteriovenous fistulas of the kidney are rare. They may be acquired, idiopathic or congenital. With the advent of interventional procedures such as percutaneous needle biopsy and percu­taneous renal access, iatrogenic fistula have become more frequent. [1] The acquired fistula after a penetrating trauma usually present with hematuria or hypertension. The time to pre­sentation following trauma may vary.

We report a case of penetrating trauma to the kidney presenting fifteen years after injury.

A 32-year-old male sustained a stab injury to the abdomen 15 years ago. He underwent emer­gency left hemicolectomy and then was appa­rently well, till he was detected to have hyper­tension during health checkup. His blood pre­ssure was 160/100 mmHg and was uncon­trolled on three antihypertensives. Duplex ultra­sound revealed a normal right kidney, bulky left kidney with focal upper calyceal dilatation and an aneurysm in the region of the left renal upper pole. Computerized tomographic (CT) angiogram revealed an aneurysm of the upper segmental artery [Figure 1]A with upper caly­ceal dilatation, and a massively dilated left re­nal vein due to arteriovenous (AV) shunting [Figure 1]B. He underwent coil embolization of the segmental artery to the upper pole [Figure 2]. At two years follow up, his hyperten­sion is under control with a single antihyper­tensive and repeat CT angiogram confirmed no evidence of AV shunting [Figure 3]. Most AV fistulae can be managed with embolization. [2]

There is little data available on hypertension following treatment of arteriovenous fistulas. Hypertension associated with arteriovenous malformations was cured in 62% of the cases after surgical treatment and surgical success was higher in patients with acquired post­traumatic fistula. [3],[4]

   References Top

1.Luscher TF, Kaplan MM. Renovascular and renal parenchymatous hypertension. Springer­Verlag: Berlin, 1992.  Back to cited text no. 1      
2.Darcq C, Guy L, Garcier JM, Boyer L, Boiteux JP. Posttraumatic secondary arteriovenous fistulae of the kidney and their embolization. Report of 3 cases. Prog Urol 2002;12(1):21-6.  Back to cited text no. 2      
3.Crotty KL, Orihuela E, Warren MM. Recent advances in the diagnosis and treatment of renal arteriovenous malformations and fistulas. J.Urol 1993;150:1355-9.  Back to cited text no. 3      
4.Morin RP, Dunnes EJ, Wright CB. Renal arterio­venous fistulas. A review of etiology, diag­nosis and management. Surgery 1986;99:114­-8.  Back to cited text no. 4      

Correspondence Address:
John Samuel Banerji
Department of Urology, Christian Medical College, Vellore
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PMID: 20427884

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  [Figure 1], [Figure 2], [Figure 3]


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