Selective embolisation for renal arteriovenous fistula-induced pulmonary hypertension

We report an alternative to nephrectomy for managing renal arteriovenous fistula (R-AVF) in patients with severe pulmonary hypertension and high-risk anaesthetic profiles. A man in his 70s, with right heart dysfunction and severe pulmonary hypertension, secondary to a left R-AVF, was deemed unsuitable for nephrectomy due to high anaesthetic risk. Instead, he underwent percutaneous transarterial embolisation, leading to significant renal function improvement and complete resolution of pulmonary hypertension on radiological imaging and clinical assessment. This is the first clinically and radiologically proven case where pulmonary hypertension, secondary to an R-AVF, was successfully treated with selective embolisation in one session. No complications occurred, highlighting selective embolisation as a safe, effective and nephron-sparing alternative to surgery for aberrant renal arteriovenous connections, particularly for patients with pulmonary hypertension and high surgical risk.