Post-biopsy arteriovenous fistula in transplant kidney: treatment with superselective transcatheter embolisation

To evaluate the technical success and therapeutic effect of superselective embolisation of arteriovenous fistulas in renal allografts.

Between 2000 and 2009, 20 patients underwent angiography of 24 AV fistulas (AVF) following percutanous biopsy of the transplanted kidney. Indications for angiography were the diagnosis of AVF by ultrasound and in addition persistent or worsening transplant renal function, or haematuria. Superselective catheterisation of the fistula was performed with a coaxial microcatheter and microcoils were used to occlude the fistula. To assess the short-term effect of embolisation, serum creatinine values were evaluated before embolisation, in the first week after embolisation and after a period of minimum 42 days after the procedure.

Angiography identified a single AVF in 16 patients and two AVFs in 4 patients. In 19 patients, successful embolisation was achieved without complications. In one patient, a second session was needed to embolise the AVF completely. The mean serum creatinine level of all patients with embolisation dropped significantly (p=0.0014) from 4.4 mg/dl (range: 1.4-11.6 mg/dl, standard deviation: 3.0) before embolisation to 2.7 mg/dl after embolisation (range: 1.0-7.0mg, standard deviation: 1.8). No patient showed an increase in serum creatinine. Long-term outcomes of the renal allograft revealed a well-functioning allograft in 19/20 patients. One patient returned to haemodialysis due to acute rejection.

Superselective transcatheter embolisation is a safe and highly effective treatment for AVFs in renal allografts. Renal function was improved in the majority of patients.