Renal Arteriovenous Shunts

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 15, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Abdomen and Pelvis: 1.50

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Body: 1.50

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

Sonography: 1.50
Procedures: 1.50
Abdomen: 1.50

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

Vascular Sonography: 1.50
Procedures: 1.50
Abdominal/Pelvic Vasculature: 1.50

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