Renal Vascular Malformation

Renal arteriovenous malformations (AVMs) and fistulae are abnormal communications between the intrarenal arterial and venous systems. Renal AVMs are usually identified during the evaluation of gross hematuria. Two types of congenital renal AVMs are described, including cirsoid AVM and cavernous congenital AVM which is the less common type. Acquired AVM or fistula can occur following trauma, especially from renal biopsy. An-giographic embolization is the preferred treatment for symptomatic AVMs. MRA is especially useful in those patients who cannot tolerate iodine-based contrast. In one study, the values for sensitivity, specificity, and accuracy using 3D PC MRA to diagnose renal vascular malformation were 78%, 100%, and 91%, respectively [17].

AVM's may as well be found in patients with re-

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Lrv b

Fig. 12a, b. Dissection of the aorta with involvement of the renal artery. Both the MIP image (a) and the surface rendered image (b) display the involvement of the renal artery (arrow in a). [Images courtesy of Dr. G. Schneider]

Fig. 12a, b. Dissection of the aorta with involvement of the renal artery. Both the MIP image (a) and the surface rendered image (b) display the involvement of the renal artery (arrow in a). [Images courtesy of Dr. G. Schneider]

Renal Cell Carcinoma Vascular
Fig. 13. AVM in a patient with renal cell carcinoma (RCC) (Gd-BOPTA, 0.1 mmol/kg). The right kidney shows 3 renal arteries of which the middle artery shows an AV-shunt (arrow) [Images courtesy of Dr. G. Schneider]
Avm With Renal Cell Carcinoma Rcc

Fig. 14a, b. AVM of the renal artery post nephrectomy and ligation of combined artery and vein (Gd-BOPTA, 0.1 mmol/kg). Note that the relationship between the renal artery and the vein on the MIP image (a) is not clear but is easily understood on the surface rendered image (arrowin b) [Images courtesy of Dr. G. Schneider]

Fig. 14a, b. AVM of the renal artery post nephrectomy and ligation of combined artery and vein (Gd-BOPTA, 0.1 mmol/kg). Note that the relationship between the renal artery and the vein on the MIP image (a) is not clear but is easily understood on the surface rendered image (arrowin b) [Images courtesy of Dr. G. Schneider]

nal tumors, in which due to tumor necrosis direct connections between larger intrarenal arteries and veins may occur (Fig. 13). In the same way AV malformations may be found rarely post nephrectomy (Fig. 14a, b) if during surgery separate ligation of the artery and the vein is not performed.

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