Idiopathic renal arteriovenous fistulas (RAVFs) are uncommon, and a left-sided inferior vena cava (IVC) is also rare. We report a large idiopathic RAVF in a 36-year-old woman who had progressive congestive heart failure. An abdominal computed tomographic scan revealed an enlarged IVC on the left side and a 5.0- × 4.5-cm RAVF with a single communication between the left renal artery and vein. Transcatheter embolization was not performed because complete flow control by a balloon catheter could not be achieved. Because of the size of the RAVF and the left-sided position of the IVC, nephrectomy was performed.
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