The endovascular treatment of a renal arteriovenous fistula: Placement of a covered stent

Abstract

We describe the case of a 40-year-old man with an acquired renal arteriovenous fistula (AVF) treated with endovascular placement of a homemade polytetrafluoroethylene covered Palmaz stent (Johnson & Johnson, Warren, NJ). The patient was seen with a abdominal bruit 5 years after exploratory laparotomy for multiple knife stab wounds. An abdominal computed tomographic scan showed an atrophic right kidney and enlarged right renal vein and inferior vena cava. Arteriography confirmed a 5-mm to 7-mm AVF between the right renal artery and vein. In November 1999, the patient was taken to the operating room where a Palmaz 308 polytetrafluoroethylene covered stent was placed within the renal artery at the site of the fistula. Exclusion of the fistula was confirmed with arteriogram. To our knowledge, this is one of the earliest reports and the longest follow-up of the endovascular placement of a covered stent for treatment of an acquired renal AVF. Continued application of covered stent treatment for renal AVFs should prove less expensive with improved renal preservation and, with prefabricated stent grafts, prove less cumbersome and time consuming than coil embolization.