Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney
Abstract Background In this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were provin...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2018-10-01
|
| Series: | CVIR Endovascular |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s42155-018-0029-x |
| _version_ | 1818025256859729920 |
|---|---|
| author | Sara ffrench-Constant Nisal Weerakoon Rahul Amin Luke Dixon David Taube Mohamad Hamady |
| author_facet | Sara ffrench-Constant Nisal Weerakoon Rahul Amin Luke Dixon David Taube Mohamad Hamady |
| author_sort | Sara ffrench-Constant |
| collection | DOAJ |
| description | Abstract Background In this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve. Case presentation Seventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline. Conclusions Percutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein. |
| first_indexed | 2024-12-10T04:13:14Z |
| format | Article |
| id | doaj.art-617d66fe669c4a2ab36515ec3d1f1ad8 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-12-10T04:13:14Z |
| publishDate | 2018-10-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-617d66fe669c4a2ab36515ec3d1f1ad82022-12-22T02:02:40ZengSpringerOpenCVIR Endovascular2520-89342018-10-01111510.1186/s42155-018-0029-xDual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidneySara ffrench-Constant0Nisal Weerakoon1Rahul Amin2Luke Dixon3David Taube4Mohamad Hamady5Imperial College Healthcare TrustImperial College LondonImperial College LondonImperial College Healthcare TrustImperial College Health TrustImperial College Healthcare TrustAbstract Background In this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve. Case presentation Seventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline. Conclusions Percutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein.http://link.springer.com/article/10.1186/s42155-018-0029-xEmbolisationBalloon assisted embolisationIatrogenic fistulaRenal transplantHigh flow arteriovenous fistula |
| spellingShingle | Sara ffrench-Constant Nisal Weerakoon Rahul Amin Luke Dixon David Taube Mohamad Hamady Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney CVIR Endovascular Embolisation Balloon assisted embolisation Iatrogenic fistula Renal transplant High flow arteriovenous fistula |
| title | Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney |
| title_full | Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney |
| title_fullStr | Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney |
| title_full_unstemmed | Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney |
| title_short | Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney |
| title_sort | dual balloon assisted super selective embolisation of high flow arterial venous fistula within a transplant kidney |
| topic | Embolisation Balloon assisted embolisation Iatrogenic fistula Renal transplant High flow arteriovenous fistula |
| url | http://link.springer.com/article/10.1186/s42155-018-0029-x |
| work_keys_str_mv | AT saraffrenchconstant dualballoonassistedsuperselectiveembolisationofhighflowarterialvenousfistulawithinatransplantkidney AT nisalweerakoon dualballoonassistedsuperselectiveembolisationofhighflowarterialvenousfistulawithinatransplantkidney AT rahulamin dualballoonassistedsuperselectiveembolisationofhighflowarterialvenousfistulawithinatransplantkidney AT lukedixon dualballoonassistedsuperselectiveembolisationofhighflowarterialvenousfistulawithinatransplantkidney AT davidtaube dualballoonassistedsuperselectiveembolisationofhighflowarterialvenousfistulawithinatransplantkidney AT mohamadhamady dualballoonassistedsuperselectiveembolisationofhighflowarterialvenousfistulawithinatransplantkidney |