Use of an Amplatzer Vascular Plug during Coil Embolization of a Renal Arteriovenous Fistula to Prevent Coil Migration

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Daniel Kim, MD, Frank Schleuter, MD, Joann Lohr, MD FACS.
Good Samaritan Hospital, Cincinnati, OH, USA.

OBJECTIVES: We report a case of a 45 year old male with a large left-sided renal arteriovenous fistula (AVF) discovered incidentally on CT scan.
METHODS: Patient underwent a CT angiogram of the aorta and renal arteries which revealed the AVF in greater detail. Contrast angiography was performed next with selection of the left renal artery. The initial plan had been to embolize the main renal artery, but upon selective angiography of the renal artery branches, the AVF was noted to arise from the superior branch alone. An Amplatzer vascular plug was placed in the superior branch prior to coil embolization to minimize the risk of coil migration.
RESULTS: Successful coil embolization was performed of the superior branch of the left renal artery, preserving flow to remaining renal parenchyma via the inferior branch as well as an accessory renal artery. Use of the Amplatzer vascular plug was instrumental in reducing the possibility of coil migration/distal embolization through the large AVF.
CONCLUSIONS: Renal arteriovenous fistulas can be safely and effectively treated with embolization via the endovascular approach. The Amplatzer vascular plug provided a safer alternative to coil embolization alone by reducing the risk of embolization into the systemic circulation.

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