Arteriovenous fistula as a complication of percutaneous nephrolithotomy in a patient with horseshoe kidney

Abstract

Clinical case description: A 48-year-old man had a history of giant platelet disorder and diagnosis of horseshoe kidney with kidney stones. Standard 24 Fr percutaneous nephrolithotomy was performed. Ten days after surgery, the patient presented with clot-forming gross hematuria, resulting in anemia. Arteriovenous fistula was suspected and evaluation at the interventional cardiology service was ordered. Arteriovenous fistula diagnosis was confirmed and superselective embolization was performed in the anterior and posterior segmental artery, with complete resolution of the hematuria.    

Relevance: To present the uncommon, post-percutaneous nephrolithotomy complication of hematuria secondary to arteriovenous fistula that was resolved through a minimally invasive technique in a patient with a kidney fusion anomaly.

Clinical implications: To take measures in that patient group to reduce what can be a life-threatening complication, managing it through superselective embolization to prevent kidney function deterioration.

Conclusions: Color Doppler ultrasound-guided percutaneous access aids in the prevention of injury to the renal vasculature during puncture and the use of miniaturized tracts can reduce the development of segmental artery lesion that could later condition fistula formation. Embolization is safe and effective in that group of patients.