High-output heart failure caused by a huge renal arteriovenous fistula after nephrectomy: Report of a case

Postnephrectomy renal arteriovenous fistula (AVF) with an aneurysmal lesion is a rare clinical entity that may cause high-output heart failure. In thi s report, we describe the case of a 68-year-old man who had undergone nephr ectomy for renal tuberculosis 43 years previously, in whom an acquired larg e renal AVF presenting as an aneurysm caused congestive cardiac failure. We also discuss the hemodynamic, hormonogenic (human arterial natriuretic pol ypeptide: hANP), and radiographic findings before and after surgery for the AVF. The AVF with an aneurysmal lesion was clearly visualized by three-dim ensional-computerized tomographic (CT) scanning, and proximal ligation of t he renal artery was followed by an uneventful recovery. This procedure can produce good results when a fistula is too large to allow safe embolization and when excision would be hazardous due to inflammation surrounding the f istula.