Paoli Hospital Physician Treats arteriovenous malformation of arteries and veins in Paoli woman’s kidney

PAOLI, Pa. (June 2008) — Increasingly short of breath and with muscle pain sapping all her energy and preventing her from sleeping, Viola Osbourne, of Paoli, underwent a minimally invasive procedure at Paoli Hospital that she said brought her almost immediate relief.

“Even before they took me back to my room, I could feel I was breathing better,” Mrs. Osbourne said of the repair of defective arteries and veins in her kidneys. “I could lift my arms, the pain was gone from my muscles. I couldn’t believe it!” Mrs. Osbourne suffered from renal arteriovenous malformations (AVMs), a tangle of arteries and veins that was interfering with the normal blood flow in her kidneys, causing a cascade of medical problems ranging from an enlarged heart and impaired kidney function to difficulty walking.

Renal AVMs occur in about one in 2,500 people. The condition can be mistaken for heart failure because patients exhibit classic heart failure symptoms—including shortness of breath and an enlarged heart, according to Paoli cardiologist Steven LaPorte, MD.

“What happens as a result of this abnormal communication of blood vessels is that blood flows directly from an artery into a vein and back to the heart. The AVMs short-circuit the circulatory process and prevent the delivery of oxygen-rich blood to the other organs,” explained Dr. LaPorte. “The volume of diverted blood, over time, floods the heart, which works harder and harder to keep up.”

Dr. LaPorte, who was first to see Mrs. Osbourne, ordered a CT scan of her lungs to help explain her shortness of breath. The scan unexpectedly revealed renal AVMs. She was referred to Paoli urologist, Gregory Thompson, MD, who requested an MRA (magnetic resonance angiogram) for more detailed information of the blood vessels in her kidneys. The MRA revealed renal AVMs in both kidneys.

“A condition like Viola’s is relatively rare,” said Dr. Thompson. “In over 20 years in practice, I’ve never seen a case like hers.” Typically, he explained, renal AVMs are treated by removing the affected kidney, but, in this case, it would require removing both kidneys, which was not an option.

By the time Mrs. Osbourne was referred to Atul Gupta, MD, Director of Interventional Radiology at Paoli, she couldn’t walk five steps without stopping to recover her breath, and fluid backing up in her chest kept her from sleeping through the night.
To correct the malformation, Dr. Gupta injected tiny, nearly microscopic, metal coils into the blood vessels through a microcatheter. The coils blocked the abnormal artery-vein connections and rerouted the blood through its normal network, which is why Mrs. Osbourne experienced relief from her symptoms so soon afterward.

“We carefully plugged up the abnormal shunts and had quite a remarkable result,” said Dr. Gupta. “She can breathe and walk without any problems, and she can sleep at night without waking up.”

Dr. Gupta credits Paoli’s sophisticated three-dimensional guidance system for allowing him to treat such complex conditions- equipment only a handful of hospitals in the world are using and equipment he is helping Philips Medical Systems perfect.

“You get a different perspective on this tangle of arteries coming out of the kidneys than you would with two-dimensional views,” said Dr. Gupta. “The 3-D guidance allows us to get our microcatheters—0.018 inches in size—into these malformations easily.”

With the fully digital, 3-D X-ray system providing unparalleled views inside the body, interventional radiologists guide tiny instruments through the network of blood vessels and other pathways directly to the problem. They’ve been able to simplify treatments for many conditions, ranging from opening blocked arteries with angioplasty to shrinking uterine fibroids, delivering cancer drugs directly to a tumor, repairing compression fractures of the spine, and treating peripheral vascular disease.

“We’re able to offer the highest quality vascular care available anywhere,” said Dr. Gupta.

Typically, only a very small incision or even simply a nick in the skin the size of a pencil point is required to gain access to the target area, avoiding costly, complex, invasive surgery. Patients benefit from less risk and pain. Scarring is minimal—a Band-Aid can usually cover the puncture site—and patients recover faster than with traditional surgery. Procedures are completed on an outpatient basis or, in complicated cases like Mrs. Osbourne’s, with an overnight hospital stay. Dr. Gupta said many her medical issues could be traced to the AVMs, which she’s apparently had since birth. AVMs in the kidneys can also be caused by biopsy or trauma. They are most common in the brain, according to Dr. Gupta, where they can cause bleeding or stroke.

Mrs. Osbourne says she is grateful to Dr. Gupta and the staff for finally getting to the root of her medical problems. “Looking back, I always wondered why I couldn’t play basketball as a youth, why I couldn’t run track—I’d be out of breath and I didn’t know why.”

At age 69, she finally has the answer.

Media Contact:
Frieda Schmidt, Public Relations
610-526-8298

Published:6-30-2008