Combined percutaneous and surgical approach to a postnephrectomy arteriovenous fistula

The case of a patient with long-standing severe heart failure that was ulti mately found to be secondary to a large communication between the right ren al artery stump and the inferior vena cava is reported. The occurrence of a n arteriovenous fistula should be suspected in patients who underwent previ ous nephrectomy since early diagnosis would avoid relevant cardiac complica tions and the demise of a patient suffering from a disease that may be corr ected surgically or percutaneously. We describe a combined approach that al lowed the percutaneous decompression of the inferior vena cava and relief o f the volume overload to the heart prior to the surgical ligation of the ar teriovenous fistula. This approach should be considered a valuable option f or treating long-standing high output postnephrectomy arteriovenous fistula s.