Renal arteriovenous malformation

Pelvis | Urology | Renal arteriovenous malformation (Disease)


Description

Renal arteriovenous malformation is an abnormal communication between the arterious and venous systems. These malformations can be congenital or acquired (often by iatrogenic means). Acquired renal arteriovenous anomalies are often termed renal arteriovenous fistulas. Renal arteriovenous malformation (AVM) usually refers to the congenital type of malformation.

Causes and Risk factors

The etiology of congenital AVMs is usually unknown, and the one for the acquired ones can be trauma (renal biopsy and during ureteroscopy), percutaneous renal biopsy or spontaneous. Patients with AVMs have gross hematuria, renal colic due to an obstructing blood clot and a major number has hypertension.

Cardiomegaly, congestive heart failure (CHF), or both also may be present among patients evaluated for renal arteriovenous malformations (AVMs). Rarely, a patient may present with hypotension from hemorrhage caused by an arteriovenous malformation (AVM). This has been described in numerous settings, including during pregnancy.

Diagnosis and Treatment

Management of AVM should be based on the cause and associated symptoms. Most congenital AVMs are small and symptomatic, and close spontaneously.

Therapeutic intervention is indicated for patients who have symptomatic AVMs presenting with persistent microscopic haematuria, massive haematuria, or frank rupture of the AVM. In the past, partial or total nephrectomy and arterial reconstructive procedures have been the most common methods of treating symptomatic AVM. However, transcatheter arteriographically directed embolisation has now gained wide acceptance for the treatment of both congenital and acquired AVMs. ...