高雄榮民總醫院 外科部 泌尿外科
Arteriovenous Fistula Caused by Zero-Time Renal Transplant Biopsy: Case Report and Literature Review
Chen-Yueh Wen, Jen-Tai Lin, Chia-Cheng Yu, Yin-Shen Chen
Divisions of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Arteriovenous(AV) fistula after kidney biopsy is a rare condition and occurs less than 0.04% of kidney transplant patients. It is a mechanical trauma caused by the biopsy needle to the arterial and venous vessel wall inducing a communication between them. Most cases remain asymptomatic. Less than 30% AV fistula have clinical manifested with elevation of blood pressure, renal function deterioration, gross hematuria and need to blood transfusion, embolization or surgery.
We herein present a 59-year-old renal transplant recipient who received zero-time renal transplant biopsy. Decreasing of urine output and intense hematuria were noticed after surgery. Urine and blood centrifugation demonstrated no evidence of hemolytic anemia. AV fistula was found in transplant renal parenchyma by sonography doppler examination and confirmed by arteriography. The AV fistula was occluded by transcatheter arterial embolization(TAE) with placement of some microcoils into the fistula from left iliac artery approach. The urine ouput increased day by day and hematuria resolved soon after TAE. Her renal function was also improved without deterioration. She remained kidney transplant protocol care and was discharged after 3 weeks.
Few cases of AV fistula had been reported after conducting zero-time renal transplant biopsy. TAE is indicated for standard treatment of most renal AV fistula because it is a less invasive method that achieves a high rate of success.