Renal Arteriovenous Fistula in a Renal Transplant Recipient: A Case Report and Literature Review

Abstract

Background. Renal arteriovenous fistula (rAVF) is a rare complication after a total nephrectomy, with only 72 cases reported in the last literature review published in 1997. AVF has never been described in a renal transplant recipient, and the possible consequences of hemodetournement on the graft function are unknown. Methods. We hereby reported the first case of rAVF occurring in a renal transplant recipient and analyzed all cases of postnephrectomy rAVF reported between 1997 and 2017. Results. A 75-year-old woman who underwent a right nephrectomy and kidney transplant 16 years earlier, and complaining of mild exercise dyspnea, was discovered with a lumbar continuous murmur. Echocardiography showed a moderate to severe dilatation of the left ventricle, with a decreased ejection fraction. Serum creatinine was slightly raised but returned to normal value with hydration. An injected computed tomography scan demonstrated a communication between the stump of the right renal artery and inferior vena cava. Total occlusion of the rAVF was obtained with Amplatzer plug and coils placed in the distal renal stump, just upstream of rAVF. Exercise dyspnea disappeared immediately, and regression of left ventricular dilatation was objectified at 6-month echocardiography follow-up. Conclusions. Postnephrectomy rAVF is rare, frequently diagnosed late, and may be responsible for high-output heart failure by left-to-right shunt, with abdominal/lumbar bruit being the only manifestation. Renal complications concern 15% of the patients. Endovascular procedure is nowadays the treatment of choice. Occluding rAVF permits cardiac hemodynamic features and heart failure symptoms resolution.

Management of Renal Artery-Inferior Vena Cava Fistula Following Nephrectomy for Penetrating Trauma

“…6,7 The most recently published literature review reported another twenty-one cases between 1997 and 2019. 4 The reported incidence of renal artery arteriovenous fistula accompanying pseudoaneurysm is less than 1%. 8 This case report adds to the published literature on this rare entity.…”

“…A well-documented risk factor for renal arteriovenous fistulae following nephrectomy is mass ligation of the renal pedicle. 3-5…”

“…A welldocumented risk factor for renal arteriovenous fistulae following nephrectomy is mass ligation of the renal pedicle. [3][4][5] The presentation of renal arteriovenous fistulae range from asymptomatic to high-output heart failure. Renal arteriovenous fistulae are likely to have high flow rates given their proximity to the aorta, thus often will not close spontaneously.…”