Obliteration of renal arteriovenous fistula by transcatheter clot embolization

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The use of selective catheterization of the main arteries or their branches which supply various organs has become the accepted method for angiography. This technique provides high quality diagnostic information and may also be used for therapeutic purposes. Control of gastrointestinal hemorrhage by transcatheter infusion of vasopressors directly into bleeding arteries in the intestinal tract is a milestone in the application of selective catheterization.1

The successful embolization of blood or particulate material at the time of surgery for obliteration of arteriovenous malformations of the brain2 suggested that transcatheter embolization might obviate the necessity for a major surgical procedure. Successful control of bleeding by trans-catheter embolization of clot into traumatically lacerated pelvic arteries has now been demonstrated.3, 4 Similar transcatheter clot embolization has been used to control gastric hemorrhage which did not respond to vasopressor infusion.5

This report illustrates the use of transcatheter embolization of clot to obliterate a renal arterio-venous fistula secondary to percutaneous renal biopsy. Included are the results of a simple in vitro experiment which was carried out in an attempt to explain the effectiveness of clot prepared by mixing the patient's blood with thrombin.

Case report

An 18-year-old white man was admitted to the Cleveland Clinic Hospital with gross hematuria. At routine physical examination 1 month prior to admission he was found to have albuminuria and microscopic hematuria. He had no facial swelling or any signs of edema, but had noted a rapid gain in weight over the past year. Because of obesity



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