Spectrum of Endovascular Embolization Techniques for the Treatment of Renal Vascular Lesions

Renal vascular lesions are rare and often asymptomatic. They can be congenital or acquired. Congenital lesions include aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulas (AVFs). Acquired lesions are usually secondary to trauma or iatrogenic injury and include pseudoaneurysms, AVFs, and vessel transection. Management of renal vascular lesions depends on the location and type of the lesion. AVMs are managed by endovascular embolization of the nidus. It can be done by transarterial route when a single or a few arterial feeders are present. The transvenous route is preferred for complete obliteration of the nidus if multiple arterial feeders and a single collector vein are present. Liquid embolic agents are the preferred embolizing agents in AVMs. Congenital or acquired AVFs are managed by coil embolization. Superselective embolization using coils or n-butyl cyanoacrylate glue is the treatment of choice for aneurysms, pseudoaneurysms, and transections involving the segmental renal arteries. Aneurysms and pseudoaneurysms involving the main renal artery are treated by stent graft placement.