Life-threatening arteriovenous fistula after percutaneous nephrostomy: A case report

Arteriovenous fistula (AVF) is a rare but serious complication following percutaneous nephrostomy. While more commonly observed after nephrolithotomy, it can also occur with prolonged nephrostomy placement or complicated procedures. Early diagnosis and management are critical for preventing life-threatening complications.

A 59-year-old female with recurrent bilateral urolithiasis, right heart failure, poorly controlled type 2 diabetes, and chronic kidney disease presented with right flank pain, fever, and fatigue. She had previously undergone right double-J stent placement but was lost to follow-up. A CT scan revealed hydronephrosis, a calcified stent, and a 22 mm pelvic stone, leading to the performance of a percutaneous nephrostomy. The patient developed an embolic stroke three days later and subsequently presented with hematuria, hypotension, and significant anemia. CT angiography confirmed an AVF with active bleeding, which was successfully treated with embolization.

Post-nephrostomy AVFs are rare, with risk factors including prolonged nephrostomy, diabetes, and complex renal stones. Early detection using Doppler ultrasound or CT angiography is crucial, and selective embolization remains the treatment of choice with a high success rate.

Post-nephrostomy AVF is a rare but potentially fatal complication requiring rapid diagnosis and intervention. Early suspicion, timely imaging, and selective embolization are key to successful management.