Case report: Asymptomatic renal arteriovenous fistula requiring endovascular embolization in a living donor transplanted kidney more than 15-years after last protocol biopsy

Abstract

Here we present the case of an HLA-identical living-donor kidney transplant recipient, who was incidentally found to have a large complex renal arteriovenous fistula (RAVF) in their transplanted kidney that had been present for nearly 6 years but was previously misinterpreted as being part of a collection of cysts. This patient had undergone 7 protocol biopsies of the transplanted kidney, the last of which had been performed approximately 16 years prior, representing the longest interval between most recent biopsy renal allograft to RAVF diagnosis in the literature date. This report reviews the etiology and principles of management for RAVF.

Keywords: PRB, Percutaneous renal biopsy; RAVF, Renal arteriovenous fistula.

Fig. 1

Pre-operative doppler ultrasound showing renal arteriovenous fistula with pseudoaneurysm in an HLA-identical living donor kidney in the left lower quadrant.

Fig. 2

CT angiogram (A), and 3D CT reconstruction (B) showing 3.2cm renal arteriovenous fistula (RAVF). The RAVF was fed almost directly by the main renal artery, apart from a few minor vessels branching prior to communication with fistula. Its appearance is consistent with the described morphology of iatrogenic RAVF secondary to percutaneous renal biopsy.

Fig. 3

Intra-operative fluoroscopic imaging of successful coiling of renal arteriovenous fistula (A) and follow up doppler ultrasound showing absence of flow to the aneurysm, consistent with successful embolization (B).