[ANEURYSMAL TYPE RENAL ARTERIOVENOUS FISTULA WITH GIANT VENOUS ANEURYSM, MIMICKING RENAL CELL CARCINOMA: A CASE REPORT].

A 39-year-old man was referred to our clinic for a 7 cm tumor in the right kidney, found by simple CT scan. It was suspected as renal cell carcinoma accompanying tumor emboli in the inferior vena cava by enhanced CT scan. For further evaluation of the tumor emboli, color Doppler ultrasound and enhanced MRI was performed. They showed a large cystic lesion with high velocity turbulent flow and flow voids in T2-weighted imaging, it seemed as giant venous aneurysm of the right renal vein. Subsequently, angiography revealed aneurysmal type renal arteriovenous fistula (AVF), transarterial embolization (TAE) of the arterial feeder with coils was performed on the same day. After 6 months from embolization, there was no recurrences or reinterventions. Color Doppler ultrasound and MRI are beneficial in distinguishing vascular disease from neoplastic disease which may sometimes mimick in other diagnostic imaging studies. In addition TAE seems to be an effective treatment for the AVF.

Soft coagulation in partial nephrectomy without renorrhaphy: feasibility of a new technique and early outcomes.

OBJECTIVES: To study the feasibility of a new partial nephrectomy technique using soft coagulation without renorrhaphy. METHODS: Open partial nephrectomy using soft coagulation without renorrhaphy was carried out on 39 consecutive patients with renal tumors. The renal artery was clamped in the initial 23 cases (59%), whereas 16 surgeries (41%) were carried out without clamping. The resected surface of the kidney was coagulated solely by soft coagulation without renorrhaphy. Suturing was used only when the urinary collecting system was opened. The surgical results and perioperative complications were retrospectively evaluated. RESULTS: The mean age of patients was 63.1 years. The mean tumor size was 28.2 mm (range 10-56 mm). The mean RENAL nephrometry score was 8.03 (range 4-10). The mean cold ischemic time (in clamped cases) was 25 min. The mean operative time was 193 min (range 113-310 min), and the mean estimated total blood loss was 172 mL (range 20-530 mL) in all cases. All operations were uneventful, and none required blood transfusion or conversion to nephrectomy. Postoperative complications, such as hemorrhage, urinary fistula formation and requirement of hemodialysis, were not observed. All patients had negative surgical margins, and were free of disease recurrence during the follow-up period (3-49 months). Overall, a remarkable decrease in renal function was not evident at the end of the follow-up period. CONCLUSIONS: This new technique using soft coagulation appears to be safe and feasible for partial nephrectomy.