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Postnephrectomy arteriovenous fistula

J C Baptista-Silva1, L F de Figueiredo, M J Castro

  • 1Hospital: Beneficência Portuguesa, Universidade Federal de São Paulo, Brazil.

Sao Paulo Medical Journal = Revista Paulista De Medicina
|May 1, 1997
PubMed
Summary
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Postnephrectomy arteriovenous fistula (PNAVF) is rare but can cause heart failure. Careful ligation of renal vessels during nephrectomy can prevent PNAVF formation.

Area of Science:

  • Urology
  • Vascular Surgery
  • Cardiology

Background:

  • Postnephrectomy arteriovenous fistula (PNAVF) is a rare complication following kidney removal surgery.
  • Clinical presentation often includes a loud murmur at the surgical site and refractory heart failure.

Observation:

  • A case report details a 58-year-old woman with unexplained heart failure 13 years post-right nephrectomy.
  • Physical examination revealed a palpable thrill and a machinery-like murmur over the previous nephrectomy scar.
  • Diagnosis was confirmed via aortogram and selective renal arteriography.

Findings:

  • Surgical excision of the arteriovenous fistula and separate ligation of the renal vessel stumps were performed.
  • The patient experienced an uneventful recovery and remained well for seven years post-operation.

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Implications:

  • Separate ligation of renal vessels during nephrectomy is crucial to prevent PNAVF.
  • Avoiding mass ligation of vessel stumps minimizes the risk of fistula formation.
  • This case highlights the importance of considering PNAVF in patients with unexplained heart failure after nephrectomy.