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| CASE REPORT |
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| Year : 2008 | Volume
: 18
| Issue : 3 | Page : 132-133 |
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Color Doppler findings of post-biopsy arteriovenous fistula in renal transplant
F Shaheen, A Hakeem, M Singh, T Gojwari, H Shafi, M Wani, S Rasool
Department of Radio-Diagnosis, Medicine and Urology, SK Institute of Medical Sciences, Jammu and Kashmir - 190 011, India
Correspondence Address:
A Hakeem
Department of Radio-Diagnosis, SK Institute of Medical Sciences, Jammu and Kashmir - 190 011
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-4065.43696
Post biopsy arterio-venous fistula in renal transplant range in incidence from 15-16%. Spontaneous resolution of 75% A-V fistulas is seen within four weeks. We report a patient with post biopsy arterio-venous fistula who had developed unexplained hypertension with no definite feature of rejection on biopsy. Doppler application revealed an arterio-venous fistula which showed spontaneous resolution in six weeks.
Keywords: Arteriovenous fistula, color Doppler, post-biopsy
How to cite this article:
Shaheen F, Hakeem A, Singh M, Gojwari T, Shafi H, Wani M, Rasool S. Color Doppler findings of post-biopsy arteriovenous fistula in renal transplant. Indian J Nephrol 2008;18:132-3 |
How to cite this URL:
Shaheen F, Hakeem A, Singh M, Gojwari T, Shafi H, Wani M, Rasool S. Color Doppler findings of post-biopsy arteriovenous fistula in renal transplant. Indian J Nephrol [serial online] 2008 [cited 2022 Mar 5];18:132-3. Available from: https://www.indianjnephrol.org/text.asp?2008/18/3/132/43696 |
| Introduction | |  |
In renal transplants post biopsy fistulas are well known. Most resolve spontaneously only few which are large need intervention. We report a case in whom we had done renal biopsy and who developed post biopsy AV fistula which we documented on color Doppler. He was followed for 6 weeks after which we noticed a spontaneous resolution. Most of the post biopsy AV fistula need follow up and are likely to resolve after some period.
| Case Report | | |
We evaluated a 46-year-old male, who had received live donor renal transplant one year ago, for a recent onset of hypertension. We performed three renal biopsies over a period of three months with no evidence of chronic transplant rejection. The patient was referred to the Radiology department for ultrasonography (USG) Doppler of the transplant. We performed a color Doppler study of the transplant kidney, which revealed an arteriovenous (AV) fistula in the lower pole involving lobar vessels with markedly increased peak systolic velocity (PSV; >170 cm/s), end diastolic velocity (EDV; >70 cm/s) and a reduced resistive index (RI = 0.45). Arterialization of the venous waveform was evident along with perivascular random color assignment [Figure 1] and [Figure 2]. The renal artery and vein at the hilum appeared normal. A follow-up after 6 weeks showed spontaneous resolution of the fistula.
| Discussion | | |
The incidence of post-biopsy renal transplant AV fistulas range from 15% to 16%. [1],[2] Only a small percentage of these fistulas are sufficiently large in size to warrant surgical intervention for closure. [3],[4] Few cases are associated with pseudoaneurysms, which if small in size, resolve simultaneously with the fistula. [2] The AV fistulas are characterized by a region of high velocity shifts with random color assignment due to vibrating interfaces in the perivascular tissue [5] and arterialization of venous flow, the latter distinguishing it from focal renal artery stenosis. [1] Most of the complications occur after renal biopsy, including AV fistulas. The AV fistulas are occluded by transcatheter embolotherapy wherein a steel coil is placed into the fistula from the renal vein approach. This procedure permits nonsurgical closure of the AV shunt without significantly altering the renal function. [6] Pseudoaneurysms are treated conservatively. [7] A spontaneous resolution of 75% in AV fistulas was noted within four weeks. All pseudoaneurysms located close to the AV fistulas are also spontaneously closed. In most cases, post-biopsy AV fistulas are clinically occult and resolve spontaneously in 1-2 years. [8]
In most cases, color and duplex Doppler USG easily demonstrate AV fistulas besides other obvious vascular and nonvascular complications and requires invasive procedures such as renal angiography.
| References | | |
| 1. | Middleton WD, Kellman GM, Melson GL, Madrazo BL. Postbiopsy renal transplant arteriovenous fistulas: Color Doppler US characteristics. Radiology 1989;171:253-7.  [PUBMED] [FULLTEXT] |
| 2. | Branderberg VM, Frank RD, Riehl J. Color coded duplex sonographic study of arteriovenous fistulas and pseudo aneurysms complicating percutaneous renal allograft biopsy. Clin Nephrol 2002;58:398-404. |
| 3. | Omolja AA, Recardio JM, McEnery PT. Postbiopsy renal arteriovenous fistula. Pediatr Transplant 2002;6:82-5. |
| 4. | Nakatani T, Uchida J, Hans YS, Iwaii T, Nakamura K, Kawashima H, et al. Renal allograft arteriovenous fistula and large pseudo aneurysm. Clin Transplant 2003;17:9-12. |
| 5. | Middleton WD, Foley WD, Lawson TL. Color flow Doppler imaging of carotid artery abnormalities. AJR Am J Roentgenol 1988;150:419-25. [PUBMED] [FULLTEXT] |
| 6. | Matsell DG, Jones DP, Bolden TF, Burton EM, Basun SL, Tonkin IL. Arteriovenous fistula after biopsy of renal transplant kidney: Diagnosis and treatment. Pediatr Nephrol 1992;6:562-4. |
| 7. | Akber SA, Jafri SZ, Amendola MA, Madrozo BL, Salem R, Kostaki G. Complications of renal transplantation. Radiographics 2005;25:1335-56. |
| 8. | De Beukalaer MM, Schrieber MH, Dodge WF, Trevis LB. Intrarenal arteriovenous fistulas following needle biopsy of the kidney. J Paediatr 1971;78:266-72. |
[Figure 1], [Figure 2]
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