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Renal arteriovenous fistulas: a review of etiology, diagnosis, and management.

ARTERIOVENOUS (A-V) FISTULAS between the renal artery and vein are being recognized with increasing frequency. The increased use of diagnostic percutaneous renal biopsy and use of diagnostic arteriography coupled with high urban violence rates are the primary responsible factors. The first intrarenal fistula was reported by Vorela’ in 1928. The earliest symptomatic cases were treated by nephrectomy. Advances in vascular surg+al techniques and interventional radiology have altered the management of such fistulas. The aim of current therapy is to preserve most or all of the functioning kidney on the involved side. Our recent experience in dealing with a patient with a large renal A-V fistula, causing progressive congestive heart failure and angina pectoris, prompted a review of the etiology, diagnosis, and management of this disease.