Endovascular Management of Traumatic Renal Artery-inferior Vena Cava Fistula in a COVID Patient

Overview

Journal BJR Case Rep

Publisher Oxford University Press

Specialty Radiology

Date 2023 Nov 6

PMID 37928708

Authors

Abhiman Baloji

Naveen Kalra

Sreedhara B Chaluvashetty

Sudheer Kumar Devana

Swati Patel

Affiliations

Soon will be listed here.

Abstract

A young teenage boy was referred to this tertiary care centre with a history of penetrating trauma to the flank. He had severe pain abdomen and gross haematuria on presentation. Imaging studies revealed a high flow direct fistulous communication between the renal artery and the inferior vena cava. On further work-up, the patient was also diagnosed with SARS-COV 2. Considering the young age of the patient, haemodynamic stability and the presence of a high flow arteriovenous fistula, endovascular management was opted. Diagnostic runs confirmed a high flow fistulous communication between the renal artery and the inferior vena cava. However, on account of logistic challenges at the time due to pandemic related restrictions, hardware accessibility was limited and hence simple coiling was contemplated. During the course of the procedure, the first coil which was deployed ran off via the fistulous communication into the inferior vena cava and got lodged in the right atrium. A separate venous access was obtained and the coil was retrieved with the help of a snare. The coil embolisation was next attempted again by starting distal to the pseudoaneurysm neck and proceeding proximally. In the end, successful coil embolisation of the fistula was done using slightly oversized coils.

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