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2.1
Renal Arteriovenous Fistula
Renal AV Fistula

Presentation

Renal arteriovenous fistula (AVF) presents a rare but important condition that can be acquired, congenital, or idiopathic. [ncbi.nlm.nih.gov]

Discussion Renal AV fistula is an unusual presentation as discussed above. It is usually difficult to diagnose. Patients usually present with hypertension and hematuria [ 3 ]. [omicsonline.org]

RAVF may be asymptomatic or present as hypertensive cardiopathy, congestive heart failure, or severe renal hematuria. We present the case of a patient with a congenital RAVF as well as high-output congestive cardiac failure. [vasculardiseasemanagement.com]

Renal AVFs should be suspected when a history of image guided percutaneous renal biopsy is present. Ultrasound Renal AVFs are usually imperceptible in B-mode. [radiopaedia.org]

Entire Body System

  • Renal Artery Stenosis

    The most common etiologies of hypertension in neonates are renal artery thrombosis, renal artery stenosis, renal anomalies, coarctation of the aorta, and bronchopulmonary dysplasia. [accesspediatrics.mhmedical.com]

    Aortogram demonstrating the coexistence of a right renal arteriovenous fistula and moderate stenosis at the origin of the right renal artery. Fig. 2. [members.sirweb.org]

    Introduction In the evaluation of hypertension, an abdominal bruit normally suggests renal artery stenosis as the cause of the hypertension. [academic.oup.com]

    Transplant renal artery stenosis (TRAS). [cjasn.asnjournals.org]

    Doppler ultrasound is highly specific in cases of transplanted renal artery stenosis, pseudoaneurysms, arteriovenous fistulas, and thrombosis with complete or partial artery or vein occlusion. [ncbi.nlm.nih.gov]

Respiratoric

  • Pertussis

    Recommended immunizations for dialysis personnel include: (a) Hepatitis B vaccine (b) Influenza vaccine, (c) Measles, mumps and rubella (MMR) vaccine, (d) Varicella vaccine and (e) tetanus, diphtheria with acellular pertussis (Tdap) vaccine [Table 12] [sjkdt.org]

Cardiovascular

  • Heart Failure

    Renal AVFs are often asymptomatic but are occasionally accompanied by hematuria or heart failure. Transcatheter closure with embolization is a safe and effective treatment for renal AVF. [ncbi.nlm.nih.gov]

  • Vascular Disease

    Although the indication for surgical treatment of renal vascular disease has decreased owing to the advancement of interventional techniques, there are still some risky cases for which surgical repair should be recommended. [ncbi.nlm.nih.gov]

    Renal Data System, USRDS 2007 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2007 Dhingra [advancedrenaleducation.com]

    Fistula Urologic Diseases Renal Insufficiency, Chronic Renal Insufficiency Pathological Conditions, Anatomical Arteriovenous Malformations Vascular Malformations Cardiovascular Abnormalities Cardiovascular Diseases Vascular Fistula Vascular Diseases [clinicaltrials.gov]

    Tunneled HD catheter Tunneled catheters (TC) are used when AVFs or AVGs are not possible to be created for several reasons, such as multiple vascular surgeries which lead to vascular thrombosis or when patients have severe peripheral vascular disease [wjgnet.com]

  • Diastolic Hypertension

    Increased renin secretion in this instance supports the proposed mechanism of diastolic hypertension with renal arteriovenous fistula. [ncbi.nlm.nih.gov]

  • Wide Pulse Pressure

    The physical manifestations of this would be a relatively normal systolic blood pressure with a decreased diastolic blood pressure resulting in a wide pulse pressure. [en.wikipedia.org]

Workup

If assessed to be at risk for rupture, a workup for associated access infection should be considered and a surgical consult for aneurysm repair initiated. Dual antiplatelet therapy should be avoided in patients with AV fistula aneurysms. [hindawi.com]

Treatment

Interventional embolization is currently the first line treatment for arteriovenous fistulas; however, the efficacy of repeated embolization remains controversial. [ncbi.nlm.nih.gov]

[…] of renal AV-fistula Endovascular therapy is the treatment of first choice: selective embolization, occlusion with coils or placement of a stent. [urology-textbook.com]

Prognosis

The advanced therapeutic tools we used can improve the prognosis of patients with large and complicated arteriovenous fistulas and prevent surgery. [ncbi.nlm.nih.gov]

Treatment and prognosis Renal AVFs usually resolve spontaneously. It may be treated whenever it is symptomatic, large or extra-renal 1,4. The therapeutic method of choice is endovascular intervention. [radiopaedia.org]

Natural history and prognosis. Ann Surg 1983; 197 (3) 348-352 9 Ogawa S, Yanagida T, Kataoka M, et al. Laparoscopic nephrectomy, ex vivo angioplasty, and renal autotransplant for a renal artery aneuryms: A case report. [thieme-connect.com]

In AKI, other considerations include: Sodium >155 mmol/L or Severe acidosis (pH Severe renal failure – e.g. creatinine >500, urea >30 mmol/L Drug toxicity with drugs than can be dialysed Prognosis Prognosis in AKI is worse if oliguria is present. [almostadoctor.co.uk]

Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci. 2011;48(4):155–170. 24. Hogevik H, Olaison L, Andersson R, Alestig K. [dovepress.com]

Etiology

Etiology of Renal AV Fistula Congenital (25%): varicose-like multiple connections between artery and vein, most common at the upper pole of the kidney, female:male = 3:1 Renal trauma Iatrogenic causes: renal biopsy, kidney surgery Inflammatory etiology [urology-textbook.com]

This book serves these needs well through a nicely balanced focus on prevention, on the one hand, with its comprehensive review of epidemiology and etiology, and on management, on the other, with its practical comments on diagnosis, treatment and outcome [books.google.de]

Etiologies include congenital, trauma, malignancies, surgery and percutaneous kidney biopsies [ 1, 3 ]. Treatment and management include transcatheter coil embolization, surgical resection, or a combination of the two for definitive treatment [ 3 ]. [omicsonline.org]

The most common etiologies of hypertension in neonates are renal artery thrombosis, renal artery stenosis, renal anomalies, coarctation of the aorta, and bronchopulmonary dysplasia. [accesspediatrics.mhmedical.com]

It is known that inflammation due to other stimuli such as syphilitic infection of the aortic wall constitutes an etiology for the development of aortocaval fistulas [19]. [egms.de]

Epidemiology

This book serves these needs well through a nicely balanced focus on prevention, on the one hand, with its comprehensive review of epidemiology and etiology, and on management, on the other, with its practical comments on diagnosis, treatment and outcome [books.google.de]

Epidemiology and outcome of infective endocarditis in hemodialysis patients. Am J Med Sci. 2002;324(5):254–260. 32. Rekik S, Trabelsi I, Hentati M, et al. [dovepress.com]

Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004;17:863-93. 21. [sjkdt.org]

Epidemiology Renal AVMs are uncommon. The estimated rate in large autopsy series is lower than 1 case per 30,000 patients. [emedicine.medscape.com]

Key words Radiocephalic fistula thrombosis, primary fistula failure, heparin in radio cephalic fistula, maturation of fistula Abbreviations AVF: Atriovenous fistula; RCF: Radiocephalic fistula; ESFF: End stage renal failure Introduction Epidemiology The [oatext.com]

Pathophysiology

The underlying pathophysiology was believed to be caused by the high-output state of pregnancy and by the increased peripheral vascular resistance of preeclampsia. [ncbi.nlm.nih.gov]

Large A-V fistula: pathophysiological consequences and therapeutic perspectives. Curr Vasc Pharmacol. 2003 Oct;1(3):347-54. DOI: 10.2174/1570161033476619 10. Nagahara A, Nishimura K, Okuyama A. [egms.de]

In 1934, Goldblatt established the pathophysiology of renovascular hypertension, showing that reduction in total blood flow because of the occluding process and the loss of pulsatile character in the artery cause the juxtaglomerular apparatus to secrete [vasculardiseasemanagement.com]

[…] disease. [3] Predisposing factors include arteriosclerosis, fibromuscular dysplasia (FMD), congenital malformations of the kidney, renal angiomyolipoma, pregnancy and trauma. [4] Traumatic and iatrogenic renal artery pseudoaneurysms represent yet another pathophysiologic [sjkdt.org]

Hemodynamics and pathophysiology of arteriovenous fistulae. In: Rutherford RB, ed. Vascular Surgery. 5th ed. Philadelphia, PA: WB Saunders; 2000. Dickey KW, Pollak JS, Meier GH III, et al. [evtoday.com]

Prevention

The advanced therapeutic tools we used can improve the prognosis of patients with large and complicated arteriovenous fistulas and prevent surgery. [ncbi.nlm.nih.gov]

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