Fogarty-assisted transcatheter embolization of a large renal high-flow arteriovenous fistula

Abstract

Background: Renal high-flow arteriovenous fistulas and its complications may involve high output heart failure, hematuria, hypertension or lethal hemorrhage. Case presentation: This case report covers the case of a 65-year-old male patient with a large renal high-flow arteriovenous fistula of the right kidney (RAVF), treated with balloon-assisted coil and liquid (n-Butyl Cyanoacrylate) embolization. By use of ballon-occlusion with an over-the-wire Fogarty catheter and advancement of a microcatheter through the lumen distal to the balloon during the transcatheter embolization of a high-flow RAVF, control of arterial blood flow is feasible by temporary occlusion of the afferent artery. This technique of flow modulation facilitates controlled deployment of embolization materials and decreases the risk of inadvertent distal embolization by use of only one 6-French (F) arterial sheath. Conclusions: Balloon-assisted embolization using a Fogarty occlusion catheter represents a feasible, safe and effective treatment option for the treatment of large, high-flow arteriovenous fistulas of the kidney.