In Reply to: Re: Case 0498_05 -- Renal transplant AV fistula detected only by CO2 arteriography posted by John Kaufman on April 05, 1998 at 23:29:46:
1) Has anyone else seen a case similar to this? Not in the kidney but I had a post cardiac catheter false aneurysm which failed to fill with regular CM but filled beautifully with CO2.
2) Does the fact that the AV fistula only filled with CO2 and not with iodinated contrast material
mean that the AV fistula is not clinically significant? No - the difference may be due to differences in flow - iodinated CM layer dependently very quickly, CO2 floats - our post cardiac catheter false aneurysm was significant
3) Was the ultrasound necessary? Probably but is there another reason for his hypertension and azotemia?? If not this at least needs evaluation with a selective arteriogram to better define the fistula and possibly asess suitability for embolization.
4) Is further imaging follow-up of this lesion required (ultrasound, arteriography, MRA)?