Therapeutic embolization of idiopathic renal arteriovenous fistula using the “stop-flow” technique

PURPOSE: To present a case of massive idiopathic arteriovenous fistula (AVF) successfully treated with an endovascular procedure. CASE REPORT: A 42-year-old woman with microscopic hematuria was found to have a massive idiopathic renal AVF. Percutaneous embolization was undertaken using a dual approach to deliver an occluding balloon through the draining vein and an arterial access to selectively catheterize the aneurysmal afferent artery. With the balloon inflated to interrupt flow ("stop-flow" technique), acrylic glue was delivered precisely to occlude the lesion. Duplex scans at 12 months have documented continued complete occlusion of the anomalous communication. CONCLUSIONS: The dual arterial and venous approach with the "stop-flow" technique makes it possible to successfully treat idiopathic AVFs that have constant high-flow connections.