CURE OF RENOVASCULAR HYPERTENSION BY PERCUTANEOUS OCCLUSION OF A LARGE IDIOPATHIC RENAL ARTERIOVENOUS-FISTULA - CASE-REPORT

Percutaneous balloon occlusion of a large hypertensive idiopathic rena l arteriovenous fistula is reported. A lumbar thrill was noted in a 52 -year-old hypertensive woman. Intravenous digital substraction angiogr aphy identified the lesion. After arteriographic assessment a percutan eous embolisation was performed with a releasable balloon positioned o n a coaxial micro-catheter. Immediate post-procedural angiographic con trol demonstrated complete occlusion with a small segmental area of re nal hypoperfusion. The lumbar thrill disappeared. Normalisation of the blood pressure was noted two days later and confirmed eight months la ter. Persistent occlusion of the fistula was angiographically confirme d, whereas the area of renal hypoperfusion had partially decreased. Re leasable balloon percutaneous embolisation appears to be a safe altern ative to surgery in the treatment of large renal arteriovenous fistula s.