신생검후 합병된 동정맥루의 초선택적 전색치료

Abstract

Arteriovenous fistulae are common complications of percutaneous renal biopsy. Such lesions usually are clinically silent, and more than 95% resolve spontaneously within two years. In rare instances, surgical correction of the fistula is required because of severe hypertension, persistent hematuria, congestive heart failure, or hydronephrosis. We present three cases of complicated arteriovenous fistulae following percutaneous renal biopsy, who were treated successfully with superselective embolization. A 3F coaxial catheter and steerable guidewire were introduced through the 5F cobra catheter and advanced into the actual site of extravasation. The tip of the guidewire was placed as possible as close to the vascular lesion. Then embolization was performed. All patients had gross hematuria at the time of angiographic evaluation. False aneurysms with anteriovenous fistula were present in two patients, and isolated arteriovenous fistula in one. Gel foam particles were used for embolization of false aneurysm/arteriovenous fistula in two patients. Isolated large arteriovenous fistula in a patient was treated with platinum micro-coil. Arteriovenous fistula occlusion with hemostasis was achieved successfully in all cases and no complications were encountered. Our experiences suggests that super selective embolization with coaxial catheter techniques is an effective method of treating complicated arteriovenous fistula after percutaneous renal biopsy without surgical correction.