renal artery to inferior vena cava fistula after nephrectomy
TRANSCRIPT
FromM
AuthE-mThethm
J Va2213Cophttp
Renal artery to inferior vena cava fistula afternephrectomyYing Liu, MD, PhD,a Jing Ren, MD, PhD,a Jun Li, MD,b and Minwen Zheng, MD, PhD,a Xi’an, China
A 70-year-old man presented with worsening shortness of breath and lowerextremity edema for 6 months. He had experienced exertional dyspneaand palpitation for 5 years. He also had a history of severe hydronephrosiswith right kidney calculi, and the right kidney had been removed 28 yearsearlier. His blood pressure was 113/56 mm Hg, and his heart rate was90 beats/min. A systolic rumbling murmur was audible on the apical region.Color-flow Doppler imaging showed mild mitral regurgitation, severetricuspid regurgitation, and a shunt from the abdominal aorta to the inferiorvena cava through a fistula (A, arrow).
An oblique transaxial contrast-enhanced dual-source computed tomog-raphy maximum-intensity projection image (B) and the posterior view ofa volume-rendered coronal projection image (C) demonstrated communica-tion (arrows) between the descending aorta (DAO) and the inferior venacava (IVC) via a tortuous aneurysmal vessel that seemed to arise from theright renal artery (RRA). The left renal artery (LRA) was normal, but theinferior vena cava and the left renal vein (LRV) were severely dilated.
A renal artery-to-inferior vena cava fistula is a rare complication afternephrectomy. The possible cause of the fistula might have been the massligation of the renal pedicle, which then developed into a pseudoaneurysm.The pseudoaneurysm of the right renal artery then eroded into the inferiorvena cava, resulting in a chronic arteriovenous fistula.1
REFERENCE
1. Lemmo G, Marrocco-Trischitta MM, Manni R, Snider F. Renal artery pseudoaneurysm andarteriovenous fistula to the inferior vena cava: a late complication following laparoscopiccholecystectomy. Am Surg 2002;68:143-5.
Submitted Oct 24, 2011; accepted Dec 1, 2011.
the Department of Radiologya and Department of Ultrasound,b Xijing Hospital, Fourthilitary Medical University.or conflict of interest: none.ail: [email protected] and reviewers of this article have no relevant financial relationships to disclose pere Journal policy that requires reviewers to decline review of any manuscript for which theyay have a conflict of interest.sc Surg: Venous and Lym Dis 2013;1:417-333X/$36.00yright � 2013 by the Society for Vascular Surgery.://dx.doi.org/10.1016/j.jvsv.2012.10.051
417