Management of Postbiopsy Arteriovenous Fistulas in Transplanted Kidneys and Effectiveness of Endovascular Treatment: A Single-center Experience

Fossaceca, Rita; Guzzardi, Giuseppe; Cerini, Paolo; Parziale, Giuseppe; Malatesta, Emanuele; Gesù, I. Di; Quaglia, Marco; Carriero, Alessandro

doi:10.1016/j.avsg.2013.04.022

Cited by 13 publications

(17 citation statements)

References 16 publications

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“…The management of asymptomatic AVF also remains controversial. Fossaceca et al recommended that angiographic embolization should be performed when AVFs are symptomatic or deterioration in renal function following allograft biopsy [20]. The recommendation is because there is no strong evidence supporting angiographic embolization for asymptomatic AVF and spontaneous resolution noted in 64-77% of patients [7,8].…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report

et al. 2017

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Arteriovenous fistula (AVF) after allograft biopsy occurs in 1.6-8.3% of kidney transplant patients and most cases remain asymptomatic. Here, we report a case of hemorrhagic shock in a kidney transplant recipient following bleeding from an AVF after graft biopsy. Immediate intensive care including angiographic embolization saved the patient and the allograft. A 62-year-old woman with end-stage renal disease caused by diabetic nephropathy underwent ABO-incompatible kidney transplantation. No complications occurred in the early postoperative period. However, serum creatinine levels did not decrease sufficiently and decreased graft diastolic blood flow was noted on ultrasound. Therefore, at 14 days after kidney transplantation, allograft biopsy was performed to elucidate the cause of allograft dysfunction. At 5 days after allograft biopsy, the patient developed hemorrhagic shock caused by bleeding from an AVF in the allograft. We immediately performed angiographic embolization, and her vital signs improved without deterioration in renal function. AVF can cause hemorrhagic shock, and angiographic embolization is effective for treating it.

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Section: Discussionmentioning

confidence: 99%

Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report

et al. 2017

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“…The presence of an arteriovenous fistula which complicates PRB both can be clinically insignificant and, in extreme cases, can cause serious hemorrhage, resistant hypertension, renal or heart failure [ 5 , 10 , 13 ]. The incidence of fistulas after PRB of native kidneys is estimated to be approximately 7.4–9 % and 8.3–16.6 % for transplanted kidneys, with approximately 1 of 5 RB-AVF is symptomatic [ 10 , 12 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…This fact, together with ignoring the diagnostic ultrasound or discontinuation of the use of the color Doppler (CD) imaging in clinically silent cases, contributes to reducing the incidence of RB-AVF. On the other hand, some sources report significant clinical complications in as many as 20–41 % of RB-AVF cases and the necessity of invasive treatment [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys

et al. 2016

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PurposeRenal biopsy-related arteriovenous fistula (RB-AVF), although usually asymptomatic, may sometimes result in serious clinical implications. The aim of the study was to prospectively evaluate the incidence of RB-AVF in native kidneys, together with the assessment of hemodynamic characteristics and the impact of the histopathological results of biopsy.Methods The study included 138 patients (age 46.2 ± 15.2; 70 F, 68 M), who underwent percutaneous renal biopsy (PRB) of the native kidney. In all patients, 2D and color Doppler ultrasound was performed 24 h after PRB in order to exclude RB-AVF.ResultsBleeding complications in the form of hematomas were found in 136 patients (98.55 %), and 23 cases of RB-AVF were observed (16.67 %). RB-AVF group had an increased maximal hematoma diameter and reduced number of glomeruli in PRB. The segmental arteries supplying the fistulas are characterized by higher maximum flow velocity (FV) and a lower resistance index (RI) compared to the normal segmental arteries (difference 45.9 ± 20.0 cm/s and 0.252 ± 0.104, respectively). In the ROC analysis, RI ≤ 0.524 allowed to detect RB-AVF with a sensitivity of 91 % and specificity of 100 % (AUC 0.998, p < 0.001). In approximately 39 % of RB-AVF cases, 2D ultrasound detected a hyperechogenic ischemic area between the fistula and the renal capsule.ConclusionsArteriovenous fistula is a quite frequent complication of native renal biopsy and can cause ischemia in the renal parenchyma detected by ultrasound. The arteries supplying the fistula are characterized by an increased flow velocity and reduced resistance index.

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“…AVFs are almost always iatrogenic, usually occurring following a graft biopsy. Although most resolve spontaneously, superselective embolization is highly effective, with minimal loss of renal parenchyma when needed [89,90].…”

Section: Angiographymentioning

confidence: 99%

ACR Appropriateness Criteria ® Renal Transplant Dysfunction

Imaging

2017

Journal of the American College of Radiology

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Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Management of Postbiopsy Arteriovenous Fistulas in Transplanted Kidneys and Effectiveness of Endovascular Treatment: A Single-center Experience

Cited by 13 publications

References 16 publications

Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report

Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report

Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys

ACR Appropriateness Criteria ® Renal Transplant Dysfunction

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