Endovascular treatment of iatrogenic arteriovenus fistula with hematuria post nephrostomy


A 73-year old male with infiltrating bladder cancer, underwent endoscopic resection. Three months later, he showed persistent hematuria and anemia so the urologists inserted a  bilateral nephrostomy to correct the hemoglobin values. Six days later, the patient still showed hematuria and low hemoglobin, so we performed an Angio-CT scan that confirmed blood in the urinary tract.

Furthermore, the arterial acquisition showed the presence of AVF with a distal pseudoaneurysm in proximity of percutaneous access.

Diagnostic Angiography

We decided to perform an endovadscular procedure to treat this complication with a mini invasive approach.

The preliminary Digital subtraction angiography, obtained through 5 French (1.67mm) diagnostic catheter, confirmed the AVF with early opacification of the renal vein (arrow) and the pseudoaneurysm (arrowhead).


A torqueable straight-shape Direxion 0.021" microcatheter was chosen to performed a superselective catheterization of an afferent vessel.

The embolization was reached using five 0.018" coils , 4 mm in diameter, in the anterior-lower segmental artery of the right kidney.

The deployment was successfully performed through the Direxion™ 0.21" (0.53mm) inner lumen.


Selective arterial embolization was achieved also thanks to Direxion slotted nitinol hypotube technology. This structure is designed to maximize torque transmission in the catheter shaft giving the microcatether a great torqueability.

The final digital subtraction angiography check confirmed the complete embolization of the vessel with disappearance of arterovenous fistula and pseudoaneurism.

Study and images courtesy of
Dr. Stefano Marcia - Chief of Radiology Department & Interventional Radiologist – “SS. Trinità Hospital” – Cagliari
Dr. Alessio SpinelliDr. Stefano Marini - Dr. Emanuele Piras - Interventional Radiologists – “SS. Trinità Hospital” – Cagliari