EURORAD ESR

Case 13814

Renal arteriovenous fistula: Which US findings are expected?

Author(s)
J.A Prat-Matifoll; Q. Ordi Camprubi; C.Hernández Giraldo; A. Salazar; S. Dyer-Hartnett; C. Gonzalez Junyent

Vall Hebron Hospital,
Institut Catala de la Salut,
Radiology;
Passeig Vall Hebrón 116-119
08035 Barcelona, Spain;
Email:joanalbertpratrx@gmail.com
 
Patient
male, 45 year(s)
 
 
  • Figure 1
    US-guided biopsy

    Core needle biopsy of the lower pole of the kidney. In this type of biopsy a hollow needle is used to remove tissue samples.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Biopsy; Special Focus: Acute;
     
     
  • Figure 2
    Doppler sonography
     

    In the lower pole of lthe eft kidney, a vascular area of aliasing is observed (red arrow). Note the presence of a segmental artery (orange arrow) and vein (blue arrow) heading towards this lesion.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Education; Special Focus: Acute;

    A feeding artery, probably an interlobar artery (orange arrows) conveys blood to the arteriovenous fistula. Note the aliasing artefact caused by a high-speed flow within the feeding artery as well as within the...

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Education; Special Focus: Acute;

    Orange arrow: Interlobar artery (feeding artery) Blue arrow: Interlobar vein (draining vein) Red arrows: Arteriovenous fistula (aliasing artefact)

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Education; Special Focus: Acute;

    Draining interlobar and segmental vein (blue arrows).

     
    Area of Interest: Education; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Drainage; Special Focus: Acute;
     
     
  • Figure 3
    Ultrasound-spectral Doppler
     

    Lower pole segmental artery with a low resistive index. The feeding artery shows a high-velocity and low-resistance waveform. This is caused by a direct arteriovenous communication avoiding the capillary bed.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Spectral Doppler; Procedure: Education; Special Focus: Acute;

    The draining vein shows a pulsatile arterialized flow.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Spectral Doppler; Procedure: History; Special Focus: Grafts;
     
     
  • Figure 4
    Bladder

    The majority of these lesions are small arteriovenous fistulas and clinically non-relevant. When these lesions are large the may cause renal ischaemia, hypertension, haematuria or haemorrhage. Note the blood clot...

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 5
    Angiography
     

    Diagnostic catheter tip (white arrowhead) in the left renal artery. Note the presence of an arteriovenous fistula (red arrows) causing an early filling of the draining vein (blue arrows).

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Catheters; Special Focus: Blood;

    Selective angiography of the lower pole segmental artery. White arrowhead: Diagnostic catheter. Yellow arrowhead: Micro-catheter in the segmental artery.

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Drainage; Special Focus: Acute;
     
     
  • Figure 6
    Embolisation: coils
     

    After using coils (green arrow), blood keeps flowing through the arteriovenous fistula (red arrow).

     
    Area of Interest: Kidney; Imaging Technique: Catheter arteriography; Procedure: Angioscopy; Special Focus: Acute;

    After using more coils (yellow arrow), blood flow could not be interrupted (red arrow).

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Arterial access; Special Focus: Acute;
     
     
  • Figure 7
    Embolisation: liquid embolic agent

    A non-adhesive liquid embolic agent (white arrows) was required to interrupt the blood flow within the fistula (red arrow).

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Ablation procedures; Special Focus: Acute;
     
     
Core needle biopsy of the lower pole of the kidney. In this type of biopsy a hollow needle is used to remove tissue samples.
 
In the lower pole of lthe eft kidney, a vascular area of aliasing is observed (red arrow). Note the presence of a segmental artery (orange arrow) and vein (blue arrow) heading towards this lesion.
 
A feeding artery, probably an interlobar artery (orange arrows) conveys blood to the arteriovenous fistula. Note the aliasing artefact caused by a high-speed flow within the feeding artery as well as within the arteriovenous fistula.
 
Orange arrow: Interlobar artery (feeding artery) Blue arrow: Interlobar vein (draining vein) Red arrows: Arteriovenous fistula (aliasing artefact)
 
Draining interlobar and segmental vein (blue arrows).
 
Lower pole segmental artery with a low resistive index. The feeding artery shows a high-velocity and low-resistance waveform. This is caused by a direct arteriovenous communication avoiding the capillary bed.
 
The draining vein shows a pulsatile arterialized flow.
 
The majority of these lesions are small arteriovenous fistulas and clinically non-relevant. When these lesions are large the may cause renal ischaemia, hypertension, haematuria or haemorrhage. Note the blood clot within the bladder.
 
Diagnostic catheter tip (white arrowhead) in the left renal artery. Note the presence of an arteriovenous fistula (red arrows) causing an early filling of the draining vein (blue arrows).
 
Selective angiography of the lower pole segmental artery. White arrowhead: Diagnostic catheter. Yellow arrowhead: Micro-catheter in the segmental artery.
 
After using coils (green arrow), blood keeps flowing through the arteriovenous fistula (red arrow).
 
After using more coils (yellow arrow), blood flow could not be interrupted (red arrow).
 
A non-adhesive liquid embolic agent (white arrows) was required to interrupt the blood flow within the fistula (red arrow).
 
 
 
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