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Nephrol Dial Transplant (1999) 14: 2726-2730
© 1999 European Renal Association-European Dialysis and Transplant Association

Clinical Observations

Endovascular treatment of arteriovenous fistulas complicating percutaneous renal biopsy in three paediatric cases

Ilmay Bilge, Izzet Rozanes1, Bülent Acunas1, Ozenç Minareci1, Ahmet Nayir, Faruk Oktem, Erdem Tonguç, Yasemen Kozok, Sevinç Emre, Haluk Ander2, Aydan Sirin and Arzu Poyanli1

Department of Pediatric Nephrology, 1 Department of Radiology and 2 Department of Pediatric Urology, University of Istanbul, Istanbul Medical Faculty, Istanbul, Turkey

Correspondence and offprint requests to: Ilmay Bilge, MD. 7–8 Kisim, D-27, B-19, Ataköy, TR-34750, Istanbul, Turkey.

Abstract

Design. We evaluated the incidence and history of arteriovenous fistula (AVF) after kidney biopsy and assessed the use of superselective embolization for treatment.

Observations. During the last 10 years, 896 kidney biopsies (age range of the patients: 1 month–18.6 years) have been performed in our institution under real-time ultrasonographic guidance with a 14 gauge cutting biopsy needle, and 32 of the patients had renal allografts (3.4%). We observed three cases of AVF (two in allograft kidneys, one in a native kidney) among all biopsies (0.34%), and the incidence of developing AVF after renal allograft biopsy was 6.3%. All three patients with AVF were symptomatic, and intravascular therapy was indicated.

Interventions. An angiographic study combined with endovascular treatment of the intrarenal AVF and pseudoaneurysm was performed in all three patients. Embolization was performed with bucrylate and lipiodol in two patients and with micro-coils in one. After successful embolization, all three patients became asymptomatic (in two renal bleeding stopped, in one patient with severe uncontrollable hypertension blood pressure returned to normal limits). No complications were observed secondary to the embolization procedure.

Conclusion. The technique of superselective embolization using a coaxial catheter is an effective and safe method in the treatment of post-biopsy AVFs and pseudoaneurysm.

Keywords: arteriovenous fistula; children; embolization; kidney biopsy


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