A renal arteriovenous fistula responsible for diastolic hypertension was repaired without sacrificing renal parenchyma by endofistulorrhaphy, a unique surgical technique.
The fistula site was localized preoperatively by selective renal arteriography. The renal artery was incised and the ostium of the efferent venous channel suture-ligated from within the depths of the artery. The fistula was successfully interrupted, and the patient has remained normotensive. Postoperative arteriography confirmed the absence of the fistula.
Vascular surgical procedures sparing renal parenchyma are relatively new, as the most common treatment for this condition had been nephrectomy.
Ehrlich RM. Renal Arteriovenous Fistula Treated by EndofistulorrhaEndofistulorrhaphy. Arch Surg. 1975;110(10):1195–1198. doi:10.1001/archsurg.1975.01360160033004