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Two patients, a 33-year-old female and 28-year-old male, were presented with sudden onset of total gross hematuria leading to non visualization of the involved kidney on excretory urogram. Diagnosis was made of multiple intra-renal arteriovenous malformation having cirsoid appearance in the selective renal arteriogram. The multiplicity and gross hematuria caused by eroding renal tissue were considered to be unquestioned indication for surgical inter-vention. Several modes of therapy aiming at the conservation of the kidney have been considered, such as partial nephrectomy, transcatheter emboliza-tion and vascular ligation. Vascular ligation can be accomplished with the minimal loss of renal tissue, but because of its technical difficulty, its indica-cation is strictly limited. The modern technology of ex vivo renal surgery, however, can expand the realm of vascular ligation even to the intrarenal arteriovenous fistula.The patients were treated successfully by ligation and division of each feeding artery by ex vivo technique and autotransplantation. Selective arte-riography of the grafted kidney taken at the 18th month after operation de-monstrated no evidence of recurrence of A-V malformation.Review of English literatures revealed that present two cases are the first publication of multiple intrarenal A-V malformation in which kidney conserving vascular surgery was carried out by utilizing ex vivo technique.

Ex-vivo surgery for treatment of intrarenal A-V malformation.