Fístula Arteriovenosa após Nefrectomia Radical: A Propósito de um Caso Clínico

there are three different types of renal arteriovenous fistula (avf), congenital, idiopathic and acquired, being the latter the most frequent. within these, those resulting from nephrectomy are rare. the avf between the renal artery and the inferior vena cava (ivc) is a rare complication, with about 10 cases described in literature. the authors describe the case of a 51 year old man, with chronic renal failure (crf) on hemodialysis, sent to a urology consultation because of a solid nodule in the right kidney, suggestive of malignancy, found by mri. he underwent radical nephrectomy and conjoined ligation of the renal pedicle, without surgical complications. four months later, fluid overload symptoms appeared, difficult to control with dialysis, associated with a continuous right abdominal flank murmur. eco-doppler and angiographic studies showed a fistula between the renal artery and the inferior vena cava. he underwent embolization of the avf with coils, and migration of the coils into the pulmonary artery occured. the collection of these was performed immediately, and without complications, with basket. subsequently, the patient was subjected to a laparotomy with simple ligation of the proximal aortic renal artery, with stabilization and resolution of clinical status. regarding this case the authors discuss the diagnostic approach and therapeutic hierarchy of renal-ivc arteriovenous fistula, in direct and endovascular surgery.