Transcatheter embolotherapy for congenital renal arteriovenous malformations. Long-term follow-up

Transcatheter embolization was performed five times in 3 patients with congenital renal arteriovenous malformations (AVM). The patients were followed for one to seven and a half years. Two patients whose AVM were completely occluded with Gelfoam have been asymptomatic with no evidence of hematuria. A third patient, embolized with Gelfoam and Ivalon without complete occlusion of the AVM, bled ten months after the first procedure, was re-embolized, and later had the AVM removed surgically. Superselective transcatheter embolization should be the initial treatment modality for congenital AVM with the aim to control bleeding and occlude those malformations supplied by the terminal portion of interlobar arteries. Large malformations supplied by multiple feeders may require operative ligation and removal of the AVM when vessels cannot be occluded satisfactorily because of massive shunting.