Endovascular Treatment of Renal AVM Using Amplatz Vascular Plug and Ethanol

Authors: Chang Won Kim

Clinical History

A 52-year-old male was admitted to department of urology for gross hematuria. CT was performed and AVM in the left kidney was diagnosed. Angiography and endovascular treatment were performed to control the gross hematuria.

Figure 1

Axial and coronal CT scans show the nidus of AVM and hematoma within the pelvis of left kidney.

Figure 2

Left renal angiogram shows AVM including feeding arteries and draining vein. Angiogram by the catheter within the nidus shows good visualization of AVM components.

Figure 3

Draining vein was embolized by an Amplatz vascular plug, 14 mm in diameter, and then arterial feeders were embolized by two microcoils and absolute ethanol 0.7 ml. There is no opacification of AVM components on post-embolization angiogram. Final image shows stagnation of contrast material within the venous aneurysm of AVM.

Figure 4

Follow-up CT scan shows complete thrombosis in venous aneurysm of AVM and small area of infarction in lower pole kidney.

  1. Renal AVM is rare disease and can be presented massive hematuria. The embolization of nidus is essential to treat AVM because of possible multiple collateral supplies. Arterial, venous and percutaneous routes are available to approach the nidus. I used arterial and venous approaches in this case. If the embolization of draining vein is successful the volume of sclerotic agent can be diminished.
  2. Amplatz vascular plug is useful to embolize large vessel. Coil is also useful however, multiple coils may be needed and migration could be occurred during the embolization. A large draining vein was embolized successfully by one Amplatz vascular plug in this case and only 0.7 ml of absolute ethanol was used to embolize multiple arterial feeders.