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Želalić S, Šimunov B, Maksimović B, Mužar R, Laganović M, Vidjak V. Successful Endovascular Treatment of Postbiopsy AVF in Transplanted Kidneys: Lessons Learned from Two Cases in Multiorgan Transplant Recipients. Int J Angiol 2024; 33:198-201. [PMID: 39131812 PMCID: PMC11315601 DOI: 10.1055/s-0043-1777256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Allograft biopsy is a cornerstone in the management of transplanted kidneys. It is a safe procedure, often performed in the outpatient setting. A rare complication is formation of a postbiopsy arteriovenous fistula (AVF). We present here a report of two cases of postbiopsy AVFs treated endovascularly. Selective embolization is a safe and effective method of treatment of postbiopsy AVFs in renal allografts.
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Affiliation(s)
- Sven Želalić
- Department of Radiology, University Hospital Merkur, Zagreb, Croatia
| | - Bojana Šimunov
- Department of Nephrology, University Hospital Merkur, Zagreb, Croatia
| | - Bojana Maksimović
- Department of Nephrology, University Hospital Merkur, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Rea Mužar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Mario Laganović
- Department of Nephrology, University Hospital Merkur, Zagreb, Croatia
| | - Vinko Vidjak
- Department of Radiology, University Hospital Merkur, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
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Tripathy TP, Fatima K, Patel RK, Alagappan A, Singh J, Mohakud S, Das MK, Nayak P. Emergency endovascular and percutaneous urological interventions: A pictorial review. Emerg Radiol 2024; 31:605-612. [PMID: 38755482 DOI: 10.1007/s10140-024-02241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Emergency endovascular and percutaneous urological interventions encompass various diagnostic and therapeutic procedures to address various genitourinary conditions. These urological interventions are life-saving in addressing complications following biopsy, post-nephrectomy, post-transplant, and post-trauma. Compared to other surgical fields, there are relatively fewer urological emergencies. However, they require prompt radiological diagnosis and urgent interventions. This pictorial essay emphasizes various urological emergencies and urgent interventional management.
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Affiliation(s)
| | - Kaneez Fatima
- Department of Radiodiagnosis, AIIMS, Bhubaneswar, India
| | - Ranjan Kumar Patel
- Department of Radiodiagnosis, AIIMS, Bhubaneswar, India.
- Department of Urology, AIIMS, Bhubaneswar, India.
| | | | - Jitender Singh
- Max Hospitals, Department of Interventional Radiology, Delhi, India
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Aoki Y, Kawamura T, Shiraga N, Yonekura T, Maeda M, Kurihara S, Sekine Y, Shishido S, Sakai K. Arteriovenous fistula in a renal allograft with gross hematuria and subsequent acute kidney injury due to urinary tract obstruction: a case report. BMC Nephrol 2023; 24:156. [PMID: 37277729 DOI: 10.1186/s12882-023-03183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) due to renal allograft biopsy is mechanical trauma resulting from the penetration of small arteries and veins by a core needle. Most AVFs are reported to resolve asymptomatically and spontaneously. This report presents a patient with acute kidney injury (AKI) due to urinary tract obstruction caused by a bleeding AVF in a renal allograft. CASE PRESENTATION A 22-year-old Japanese woman who underwent living-donor kidney transplantation (KT) at 3 years due to end-stage renal disease caused by focal segmental glomerulosclerosis (FSGS) presented with a renal transplant AVF (gourd-shaped; 42 × 19 × 20 mm). The AVF was unexpectedly discovered by ultrasound before a surveillance biopsy at 10 years after KT. The patient had a history of recurrent FSGS, had undergone several renal allograft biopsies after KT, and did not experience symptoms or growth of the AVF for years. Nineteen years after KT, the patient developed AKI with sudden, asymptomatic, gross hematuria and anuria. Plain computed tomography revealed a hematoma in the pelvis of the renal allograft and bladder tamponade. The AVF was successfully treated by coil embolization. Hemodialysis was performed for AKI, and graft function was gradually recovered. CONCLUSIONS Unexpected bleeding from a renal transplant AVF may lead to transplant dysfunction. Angiographic embolization against the ruptured renal transplant AVF may prevent rebleeding and rescue the renal allograft.
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Affiliation(s)
- Yujiro Aoki
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Takeshi Kawamura
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Nobuyuki Shiraga
- Department of Diagnostic Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takashi Yonekura
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Maho Maeda
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Sota Kurihara
- Department of Urology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Postoperative and Recurrent Hematuria after Pretransplant Core Needle Biopsy in Living Donor Kidney Transplant. Case Rep Transplant 2022; 2022:5274521. [PMID: 35937758 PMCID: PMC9352472 DOI: 10.1155/2022/5274521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Core needle and wedge biopsies are the two main pathologic ways to determine the suitability of a kidney allograft and to have a baseline allograft biopsy in case of future rejection. Case Presentation. A 57-year-old patient developed a renal arteriovenous fistula causing postoperative and recurrent hematuria after allograft pretransplant renal core needle biopsy and treated with selective Interventional radiology coil embolization. Conclusion Delayed profound hematuria can be seen after pretransplant core needle renal biopsies and can recur again even after complete resolution, due to arteriovenous fistula formation in the renal calyceal system.
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Serna-Higuita LM, Zuluaga-Quintero M, Hidalgo-Oviedo JM, Vallejo SA, Aristizabal-Alzate A, Zuluaga-Valencia GA, Nieto-Ríos JF. Treatment of Post-biopsy Arteriovenous Fistula of a Renal Graft by Selective Embolization. Indian J Nephrol 2021; 31:201-204. [PMID: 34267449 PMCID: PMC8240940 DOI: 10.4103/ijn.ijn_351_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/17/2019] [Accepted: 03/19/2020] [Indexed: 11/04/2022] Open
Abstract
The development of an arteriovenous fistula (AVF) after renal graft biopsy is a rare complication, it is associated in most cases with spontaneous resolution. However, interventional therapies are required in some cases, to prevent graft loss. Selective embolization has been described as an alternative treatment. In the present study, we describes our experience on AVF after biopsy in kidney transplant patients, which was managed with selective embolization. From 2005 to 2015, a total of 452 kidney transplant biopsies were performed, 12 had an AVF requiring embolization. In 92% of cases, this was successful. Beforehand, mean serum creatinine levels were 2.45 mg/dL, after the procedure, that increased to 3.05, however, 3 months later, mean creatinine levels dropped to 1.85 mg/dL. Graft survival after 2 follow-up years was 72%. Our experience demonstrates that selective embolization of the AVF after kidney transplant biopsy is a safe procedure, and that transplant function can be maintained in patients with this complication.
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Affiliation(s)
- Lina M Serna-Higuita
- Eberhard Karls University, Institute of Clinical Epidemiology and Biometrics, Tuebingen, Germany
| | | | | | | | | | | | - John F Nieto-Ríos
- Department of Nephrology and Kidney Transplant Pablo Tobón Uribe Hospital, Medellín, Colombia.,Department of Internal Medicine, University of Antioquia, Medellin-Colombia
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Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report. CEN Case Rep 2018; 7:5-8. [DOI: 10.1007/s13730-017-0279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022] Open
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Taffel MT, Nikolaidis P, Beland MD, Blaufox MD, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, Heller MT, Khatri G, Preminger GM, Purysko AS, Smith AD, Wang ZJ, Weinfeld RM, Wong-You-Cheong JJ, Remer EM, Lockhart ME. ACR Appropriateness Criteria ® Renal Transplant Dysfunction. J Am Coll Radiol 2018; 14:S272-S281. [PMID: 28473084 DOI: 10.1016/j.jacr.2017.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
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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Affiliation(s)
| | - Myles T Taffel
- Principal Author, George Washington University Hospital, Washington, District of Columbia.
| | - Paul Nikolaidis
- Panel Vice-chair, Northwestern University, Chicago, Illinois
| | | | - M Donald Blaufox
- Albert Einstein College of Medicine, Bronx, New York; Society of Nuclear Medicine and Molecular Imaging
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia; Pennsylvania, American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | | | | | | | | | - Glenn M Preminger
- Duke University Medical Center, Durham, North Carolina; American Urological Association
| | | | - Andrew D Smith
- The University of Mississippi Medical Center, Jackson, Mississippi
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
| | | | | | - Mark E Lockhart
- Panel Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Lubas A, Wojtecka A, Smoszna J, Koziński P, Frankowska E, Niemczyk S. Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys. Int Urol Nephrol 2016; 48:1667-73. [PMID: 27580732 PMCID: PMC5031753 DOI: 10.1007/s11255-016-1411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
Abstract
Purpose Renal 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. Results Bleeding 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. Conclusions Arteriovenous 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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Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
| | - Anna Wojtecka
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Jerzy Smoszna
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Koziński
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Emilia Frankowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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Glebova NO, Brooke BS, Desai NM, Lum YW. Endovascular interventions for managing vascular complication of renal transplantation. Semin Vasc Surg 2014; 26:205-12. [PMID: 25220328 DOI: 10.1053/j.semvascsurg.2014.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal transplantation is a well-established treatment for patients with end-stage renal disease. Although the procedure is commonly undertaken with a high rate of initial technical success, a low but significant risk of vascular complications can develop and ultimately threaten the transplanted kidney. Complications include transplant renal artery stenosis, extraparenchymal and intraparenchymal pseudoaneurysm and arteriovenous fistula formation, and stenosis of native iliac arteries due to aortoiliac occlusive disease. Historically, open surgical correction of these complications has been associated with high morbidity and the risk of graft loss. Endovascular approaches are better tolerated by renal transplantation patients and are used increasingly for management of vascular complications associated with kidney transplantation. We review the contemporary diagnosis and treatment of these complications using endovascular techniques.
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Affiliation(s)
- Natalia O Glebova
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Niraj M Desai
- Division of Transplant Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Ying Wei Lum
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
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