Download VISCERAL ANGIOGRAM PROCEDURE: Flush aortogram and left

VISCERAL ANGIOGRAM
PROCEDURE: Flush aortogram and left renal arteriogram.
MEDICATIONS: Ancef 1 gm, Versed 3 mg, Fentanyl 150 mcg.
CONTRAST: 100 cc Visipaque.
FLUOROSCOPY: 3 minutes.
HISTORY: The patient has an arteriovenous fistula in the left kidney. Physician requests arteriography prior to
nephrectomy.
TECHNIQUE: Informed written consent was obtained. Intravenous access was established. The patient’s
blood pressure, EKG, and oxygen saturation were monitored. The left and right groins were prepped and
draped in the usual fashion.
The left common femoral artery was accessed using a 19 gauge needle and single wall puncture technique. An
035 Bentsen guidewire was advanced through the needle and directed into the abdominal aorta under
fluoroscopic guidance. A 5 Fr calibrated pigtail catheter was advanced over the wire and positioned in the
pararenal aorta. Aortography was performed in the AP projection. Pigtail catheter was exchanged over a wire
and replaced with a SOS Omni catheter. The left renal artery was selected with the catheter. Selective renal
arteriography was performed in multiple projections. The catheter was removed. Sheath was removed and
hemostasis was established by applying direct pressure to the puncture site.
FINDINGS: Initial aortogram demonstrates a normal appearing abdominal aorta and proximal right and left
common iliac arteries. The right renal artery is not well opacified and no flow is noted into the right kidney.
The left renal artery is markedly dilated and tortuous. There is early filling of a complex mass of veins within
the hilum of the left kidney, consistent with an ateriovenous fistula. The left renal vein is markedly dilated and
brisk flow is noted into the inferior vena cava. The left renal vein is of the same caliber as the inferior vena cava.
Multiple projections of the left kidney were obtained. The exact location for the arteriovenous fistula is not
visualized.
IMPRESSION: There is an arteriovenous fistula in the left kidney. The left renal artery is markedly dilated and
tortuous. There is early filling of complex dilated venous system in the hilum of the left kidney. The left renal
vein is markedly dilated and appears of the same caliber as the inferior vena cava.
The right renal artery appears atretic and no flow is visualized into the right kidney.