Balloon-Assisted Endovascular Embolization of High-Flow Renal Arteriovenous Fistula

High-flow renal arteriovenous fistula (AVF) can lead to complications such as hematuria, hypertension, high-output cardiac failure, and renal insufficiency.[1] [2] A 52-year-old female patient with no prior risk factors presented with dull aching pain in right lumbar quadrant for 1 month and hematuria for 7 days. There was no history of trauma to abdomen. She was hemodynamically stable at presentation. Her hemoglobin was 6.9 g/dL. Abdominal ultrasound showed a large anechoic cystic lesion in the right lumbar quadrant with only upper pole of right kidney being visualized and intense color flow within the lesion in color Doppler with low resistance biphasic waveform ([Fig. 1A]). Chest radiograph was normal. Computed tomography angiography revealed a large vascular pouch in the right kidney with a large arterial feeder and dilated early draining renal vein suggestive of renal AVF with large venous pouch ([Fig. 1B]). Diethylenetriaminepentacetate (DTPA) scan showed severely impaired renal perfusion and cortical function in right kidney with functioning parenchyma seen exclusively at upper polar region. She was counseled for endovascular treatment as upper pole of right kidney could be preserved.