A very rare cause of congestive heart failure: renal arterio-venous fistula

Introduction: In both the open and laparoscopic nephrectomy, the standard approach to the division of the renal pedicle is the individual isolation and occlusion of the renal artery followed by the renal vein. En bloc ligation of the renal vessels may result in the development of post-nephrectomy renal arteriovenous fistulas (AVF). Although rare, AVF may lead to arterial hypertension, abdominal bruits, tachycardia, flank pain and congestive heart failure. Methods: We report the case of a 40 years old woman presenting with exertion dyspnea and right flank pain due to a large communication between the right renal artery and the inferior vena cava with high-flow fistula, diagnosed imagistically 20 years after right lumbar nephrectomy for non-functioning kidney related to stone disease. Available treatment options include either angiographic embolization, or open surgical ligation of the feeder vessel, with or without the excision of the fistula sac. The patient underwent surgical intervention with successful excision of the aneurismal sac and abolition of the fistula. Results: We identified a potential risk factor for the formation of renal AVF after nephrectomy. We also review the existing literature for other risk factors involved in the genesis of this complication. Conclusions: It is essential to ligate renal vessels individually during nephrectomy. Joint ligation of vessels of the renal pedicle may result in AVF formation. We underline the great importance of imagistic techniques during postoperative follow-up in order to timely diagnose such a complication.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)