Posttraumatic arteriovenous fistula and pseudoaneurysm of renal artery complicated with hemodynamic disturbances and cirrhosis
Article published in Urologia Polska 2004/57/4.

authors

Marek Długosz ¹, Krzysztof Bar ², Jerzy Stanisławek ³, Adam Prażanowski ¹, Grzegorz Zarzycki ¹, Andrzej Niewczas ¹

¹ Oddział Urologiczny Szpitala Miejskiego w Ostrowcu Świętokrzyskim
Ordynator oddziału: lek. med. Marek Długosz
² Katedra i Klinika Urologii Akademii Medycznej w Lublinie
Kierownik kliniki: prof. dr hab. Krzysztof Bar
³ Oddział Chirurgiczny Szpitala Miejskiego w Ostrowcu Świętokrzyskim
Ordynator oddziału: dr med. Jerzy Stanisławek

keywords

kidney, arteriovenous fistula, pseudoaneurysm

summary

introduction

There are iatrogenic (arterial catheterization in order to perform arteriography, sometimes PCNL) or noniatrogenic (blunt trauma, stab wounds) reasons of arteriovenous fistulas and pseudoaneurysms [1,2]. Arteriovenous fistulas may also result from chronic pathological process involving renal vessels. Sometimes it may be congenital. Infection or inflammatory diseases of vessels may also lead to pseudoaneurysms. Diagnosis is often very difficult [3]. Undiagnosed arteriovenous fistulas entail serious hemodynamic complications [4]. Case of a patients with a history of injury (stab wound within left loin) with diagnosis of pseudoaneurysm of renal artery and arteriovenous fistula with serious complications such as cardiac failure, hypertension and renal cirrhosis is presented.

the purpose of the study

The aim of the study is to present a case of large pseudoaneurysm of left renal artery and arteriovenous fistula with serious complications such as cardiac failure, hypertension and renal cirrhosis. The diagnosis was done 6 years after the injurie (stub wound within the left loin).

materials and methods

41 years old was injured within left loin 6 years ago. He was treated conservatively then. He was admitted to the hospital because of renal cirrhosis and suspition of renal aneurysm. Arteriography, CT, ultrasound scan, intravenous pyelography and ultrasound examination of the heart were performed.

results

Examinations have shown pseudoaneurysm of renal artery and arteriovenous fistula. Ultrasound of the heart revealed decreased ejection fraction (40%), heart and pulmonary circulation overload and enormous cardiac hypertrophy. He was operated on after the cardiological assessment. During the operation small, cirrhotic kidney, large pseudoaneurysm of renal artery and arteriovenous fistula between aorta and renal vein were found. The kidney was removed and the fistula was repaired. There were no perioperative complications. Five months after the operation no hemodynamic disturbances and normotension was present.

conclusions

Late diagnosis of complications of stab injuries within loins - pseudoaneurysm of renal artery and arteriovenous fistula - may be the reason of serious disturbances such as cardiac failure, hypertension or renal cirrhosis.

references

correspondence