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Complete Renal Artery Embolization in a Comorbid Patient with an Arteriovenous Malformation

DOI: 10.1155/2014/856059

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Renal arteriovenous malformations are uncommon and are rarely a cause for presentation. However, they can occasionally pose life-threatening problems. We present a case of an elderly female who underwent a complete left renal artery embolization, following a difficult presentation complicated by advanced dementia and multiple comorbidities. This is the first documented case of complete renal artery embolisation used to treat a renal AVM. 1. Introduction Renal arteriovenous malformations (AVMs) are aberrant connections between the renal artery and vein. They may be acquired or congenital in their aetiology [1]. The most common presenting complaint is of visible haematuria. It is AS part of the routine workup for frank haematuria that intrarenal AVMs are diagnosed [2]. Other presentations include hypertension of unknown cause, abdominal pain, and left ventricular hypertrophy [1, 2]. In cases where patients are unstable requiring intervention, the historical treatment has been partial or total nephrectomy with arterial reconstruction [2]. Over time, the range of options has evolved to include conservative and angiographic procedures [2]. We present the only documented case of complete renal artery ablation being used in the acute setting. 2. Case Presentation A frail 76-year-old lady with vascular dementia presented with a five-week history of malaise and persistent gross haematuria. Other than dysuria she had no other lower urinary tract symptoms. Her past medical history consisted of chronic hyponatraemia, advanced vascular dementia, osteoarthritis, and glaucoma. On admission, she looked unwell and had pallor but was haemodynamically stable. Her abdomen was soft and nontender, her lung fields were clear, and her heart sounds normal. Her haemoglobin was 11.9?g/dL and WBC was /L, and she had a grossly normal renal function with urea of 13.4. Her CRP was not performed. The initial working diagnosis was of a urinary tract infection and she was commenced on oral coamoxiclav. She responded well initially but soon deteriorated passing further frank blood necessitating blood transfusion. As part of her haematuria workup, a renal tract ultrasound was performed. This showed a calcific density in the right kidney whilst the left appeared normal. The bladder was noted to contain an adherent mass consistent with clots. A 3-way catheter was sited and regular washouts and irrigation were instated. After passing old clots, the urine promptly cleared but the following day she became septic and was treated aggressively with fluid resuscitation and intravenous coamoxiclav

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