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A conservative approach to traumatic intrarenal arteriovenous fistulae: experience with 13 cases.

Thirteen patients with traumatic intrarenal arteriovenous fistulae due to blunt, penetrating and iatrogenic injury are reported. The major clinical feature in this series was renal haemorrhage. Conservative treatment resulted in spontaneous closure of the fistula and cessation of bleeding in 6 patients. Nephrectomy was performed in 3 patients for refractory haemorrhage, but a conservative operation would have been preferable. Renal segmental artery ligation was effective in controlling renal haemorrhage and promoting closure of the fistula in 4 patients. No adverse sequelae occurred following segmental artery ligation. The initial management of traumatic intrarenal arteriovenous fistulae should be conservative. Segmental artery ligation is recommended for the relief of persistent pain and control of renal haemorrhage.