Tlaiss Yehya, Najjar Aziz M, Tlais Mohamad, Noun Peter, Ghantous Imad
Urology, University of Balamand, Beirut, LBN.
Urology, Hôpitaux Universitaires Pitié Salpêtrière, Paris, FRA.
Cureus. 2024 Feb 29;16(2):e55218. doi: 10.7759/cureus.55218. eCollection 2024 Feb.
This case report details the management of a 66-year-old male with hemophilia A (HA) who presented with recurrent hematuria, and was found to have renal artery aneurysms and was subsequently diagnosed with a renal arteriovenous (AV) shunt. While the primary focus centers on the successful endovascular coil embolization of renal artery aneurysms, the concomitant presence of the AV shunt accentuates the significance of this case. Imaging techniques were crucial in the discovery of renal aneurysms and the diagnosis of the AV shunt malformation of the renal artery. This included an ultrasound, CT-angiography and digital subtraction angiography. The treatment approach employed prioritized endovascular coil embolization for its efficacy and reduced morbidity. Following the initial successful embolization, the identification of the AV shunt during subsequent embolization led to its targeted treatment. The case was also complicated by acute prostatitis that was treated medically. The patient's HA required careful administration of coagulation factor replacement therapy to control bleeding throughout the process. This case highlights the importance of reporting on the management of rare and complex pathologies to better understand and guide future treatments, especially involving this rare combination of renal AV shunts and hemophilia A.
本病例报告详细介绍了一名66岁甲型血友病（HA）男性患者的治疗情况。该患者反复出现血尿，检查发现患有肾动脉瘤，随后被诊断为肾动静脉分流。虽然主要重点是肾动脉瘤成功的血管内弹簧圈栓塞术，但动静脉分流的同时存在凸显了该病例的重要性。成像技术在发现肾动脉瘤和诊断肾动脉动静脉分流畸形方面至关重要。这包括超声、CT血管造影和数字减影血管造影。治疗方法优先采用血管内弹簧圈栓塞术，因其疗效好且发病率低。在首次成功栓塞后，后续栓塞过程中发现动静脉分流并对其进行了靶向治疗。该病例还并发急性前列腺炎，通过药物治疗。患者的甲型血友病在整个过程中需要谨慎给予凝血因子替代疗法以控制出血。本病例强调了报告罕见和复杂病症治疗情况的重要性，以便更好地理解和指导未来的治疗，特别是涉及这种罕见的肾动静脉分流和甲型血友病组合的情况。
