Renal Arteriovenous Shunts

The classification, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal arteriovenous shunts are described.

Course ID: Q00502 Category:
Modalities: , , ,

2.5

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Computed Tomography: 2.50
Procedures: 2.50
Abdomen and Pelvis: 2.50

Magnetic Resonance Imaging: 2.50
Procedures: 2.50
Body: 2.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Abdominal Section: 2.50

Sonography: 2.50
Procedures: 2.50
Abdomen: 2.50

Vascular-Interventional Radiography: 2.50
Procedures: 2.50
Vascular Diagnostic Procedures: 0.50
Vascular Interventional Procedures: 2.00

Vascular Sonography: 2.50
Procedures: 2.50
Abdominal/Pelvic Vasculature: 2.50

Outline

  1. Introduction
  2. Classification of Renal AV Shunts
  3. Etiology
    1. Traumatic Renal AV Shunts
    2. Nontraumatic Renal AV Shunts
  4. Clinical Features
  5. Imaging Features of Renal AV Shunts
    1. Normal Anatomy of Renal Arteries and Veins
    2. Imaging Features of Renal AV Shunts
      1. US
      2. CT
      3. MR Imaging
      4. DSA
  6. Endovascular Treatment
    1. Techniques
    2. Type III Nontraumatic Renal AV Shunts
      1. Particles
      2. Liquid Embolic Materials
      3. Absolute Alcohol
      4. NBCA
      5. Onyx
    3. Type I Nontraumatic Renal AV Shunts
    4. Type II Nontraumatic Renal AV Shunts
    5. Traumatic Renal AV Shunts
  7. Postembolization Care
  8. Conslusions

Objectives

Upon completion of this course, students will:

  1. identify the indications for treatment of renal AV shunts
  2. discuss the advantages of endovascular embolization compared to surgical treatment of renal AV shunts
  3. identify the complications of endovascular embolization of renal AV shunts
  4. describe the types of AV shunts using the Cho classification
  5. discuss the traditional classification of non-traumatic renal AV shunts
  6. classify cirsoid and aneurysmal non-traumatic renal AV shunts using the Cho classification system
  7. identify the most common cause of traumatic renal AV shunts
  8. identify features related to traumatic renal AV shunts
  9. classify renal malformations using the Cho classification system
  10. identify the causes of renal AV fistulas
  11. define nidus
  12. identify symptoms of patients with renal AV shunts
  13. discuss the cause of arterial hypertension in patients with renal AV shunts
  14. identify the subdivisions of the renal artery which are commonly involved in nontraumatic renal AV shunts
  15. describe the imaging features of renal AV shunts on ultrasound
  16. identify the limitations of ultrasound in the evaluation of renal AV shunts
  17. identify optimum CT parameters to detect renal AV shunts
  18. describe the uses of time resolved CT angiography in the evaluation of renal AV shunts
  19. identify the limitations of CT in the evaluation and follow-up of renal AV shunts
  20. identify the MR imaging features of renal AV shunts
  21. identify optimum technical factors for 3D contrast-enhanced MR angiography to image renal AV shunts
  22. identify the uses of DSA in the evaluation of renal AV shunts
  23. discuss features of renal AV shunts to be evaluated using DSA in pretherapeutic planning
  24. describe techniques to image high flow renal AV shunts using DSA
  25. identify the most appropriate modalities to perform post embolization follow-up imaging of renal AV shunts
  26. describe successful embolization of renal AV shunts
  27. identify factors contributing to the appropriate selection of embolic material when treating renal AV shunts
  28. discuss the complications of the use of particles in patients with type III nontraumatic renal AV shunts
  29. identify embolic materials that are not recommended for treatment of nontraumatic renal AV shunts
  30. describe the effects of absolute alcohol on the vessel and how this contributes to embolization
  31. discuss the complications of the use of absolute alcohol in the treatment of renal AV shunts
  32. identify contrast material which is used with NBCA for treatment of renal AV shunts
  33. identify the concentration of NBCA most often used to embolize type III nontraumatic renal AV shunts
  34. describe the key points for injection of NBCA in the treatment of nontraumatic renal AV shunts
  35. identify special consideration in catheter selection when using Onyx embolic material
  36. discuss the complications associated with the use of Onyx embolic material for treatment of type III nontraumatic renal AV shunts
  37. discuss techniques to minimize renal infarction during embolization of type I nontraumatic AV shunts with detachable coils
  38. identify patients with large AV fistulas who are not candidates for embolization using vascular plugs
  39. identify the structures which must be embolized to ensure successful occlusion of type II nontraumatic renal AV shunts
  40. compare the embolization techniques of type I and type II nontraumatic renal AV shunts
  41. be familiar with the post-embolization prophylactic medications administered to patients
  42. know the most common complication following embolization of renal AC shunts