A 77-year-old patient, nephrectomized 40 years ago for lithiasic pyelonephrosis, presented with continuous flank pain and dyspnea symptoms plus right progressive swelling of the right flank one month.
On physical examination, it is noteworthy the auscultation of a continuous murmur on the right flank and on chest X-ray, an increase in the size of the cardiac silhouette and both pulmonary hilium.
An Ambulatory Computerized Axial Tomography (CAT) with multiplanar reconstruction of Angio-CT is requested, where an aneurysmal dilatation of the distal end of the right renal artery of 3x2 cm is observed.
The patient was diagnosed with arteriovenous fistula and percutaneous embolization of the fistula was scheduled.
Two days before embolization, the patient came to the emergency department complaining of an episode of nonspecific biventricular heart failure requiring anticoagulant therapy.
Once the heart failure condition was stabilized, right renal arteriography and metallic embolization of the fistula were performed, proving immediately the absence of arteriovenous communication.
At 24 hours the patient was clinically asymptomatic.
At 12 months there was no clinical recurrence.
