1982 Volume 73 Issue 3 Pages 316-325
Arteriovenous fistulae secondary to renal cell carcinoma are uncommonly encountered, but these fistulae have much interesting clinical features.
Of 50 patients of renal cell carcinoma treated at the Jikei University Hospital during the 8 years from January 1972 to December 1979, arteriovenous fistula secondary to renal cell carcinoma was demonstrated angiographically in 6 patients.
In contrast to patients without renal arteriovenous fistula (average age 54 years old), patients with this pathological condition (average age 61 years old) were generally in the older age group.
Our patients did not show typical clinical picture when compared to patients reported from other countries. That is, the patient was female and presented with cardiovascular symptoms. But of these 6 patients, 5 were male and 1 was female. Severe cardiovascular complaints, which were reported previously in the literature on arteriovenous fistula associated with renal cell carcinoma, have not been reported in our country.
Among these 6 patients, the presence of tumor thrombus from the renal vein to the inferior vena cava was revealed in 3 cases (50%) by nephrectomy. On the other hand, the presence of tumor thrombus was revealed in 10 patients out of the remaining 44 patients (23%). Threfore, the patients with arteriovenous fistula associated with renal cell carcinoma have a high incidence of tumor thrombus, in contrast to those without it.
As to the clinical courses of the 6 patients, 2 of them demonstrated distant metastases (33%), and 12 patients of the remainning 44 (27%) demonstrated distant metastases. Thus, the patients with arteriovenous fistula did not show high incidence of complication of distant metastasis.
As to the prognosis, 2 of the 6 patients with metastatic lesion died and 1 of the 6 patients died of hemorrhage in the gastrointestinal tract after nephrectomy. On the contrary, 3 of the 6 patients who was nephrectomized have survived till now, from one year and 11 months to 2 years. Therefore, even in the presence of arteriovenous fistula associated with renal cell carcinoma, a prolonged survival period can be expected.
