Percapsular and percutaneous embolization of renal transplant pseudoaneurysm and AV fistula: case report

Renal allograft arteriovenous (AV) fistula is a known complication of renal biopsies in patients experiencing renal allograft dysfunction. Treatment may include observation, surgery, or intraarterial embolization. We report a case of postbiopsy renal allograft AV fistula and pseudoaneurysm in which intraarterial embolization was technically impossible. Treatment included percapsular embolization of the pseudoaneurysm using intraoperative ultrasound guidance. The embolization coils served as a guide for subsequent percutaneous embolization of the AV fistula in the angiographic suite. Innovative embolization techniques may be necessary in order to preserve optimal renal function.