Kidney Week

Abstract: SA-PO1181

Evolution over a Decade: An Exceptionally Persistent Postbiopsy Renal Arteriovenous Fistula

Session Information

• Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• García Gonzalez, Maria Fernanda, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Méx., Mexico

Maria Fernanda García Gonzalez, MD

• Vergara Zavala, Octavio, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Méx., Mexico

Octavio Vergara Zavala, MD

• Cortez, Brenda, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Méx., Mexico

Brenda Cortez, MD

• Moguel, Bernardo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Méx., Mexico

Bernardo Moguel, MD

Introduction

Renal allograft biopsy is essential for diagnosis, treatment guidance and prognostic assessment. However, it is not without complications. Arteriovenous fistulas (AVF) often require intentional screening with Doppler ultrasound for detection and helped distinguish patients who require therapeutic intervention from those suitable for conservative management. Reported incidence varies among centers ranging from 10–15% in renal allografts.

Case Description

A 43-year-old man with end-stage kidney disease and antiphospholipid syndrome underwent a second successful living-related kidney transplant after early thrombosis and rupture of the first graft. Seven years later, he presented an event of acute graft dysfunction and an ultrasound-guided renal allograft biopsy was performed without immediate complications.Two years later Doppler ultrasound incidentally identified a 9 × 7 mm a post-biopsy AVF. Seven years later, follow-up imaging demonstrated progressive enlargement to 20.4 × 15.7 mm, while the patient remained asymptomatic. Fourteen years after biopsy CT angiography confirmed a 27 × 20 mm AVF associated with a 6.4 × 4.2 mm pseudoaneurysm arising from the superior segmental artery. Despite progressive enlargement the patient remained asymptomatic and endovascular treatment was indicated, but the patient declined it.

Discussion

AVF and pseudoaneurysms are usually asymptomatic and self-limited vascular complications following renal biopsy. Most AVF resolve spontaneously within the first 90 days after biopsy, while only a minority persist and require intervention. This case illustrates the uncommon prolonged natural history of a renal allograft AVF followed during more than a decade, with gradual enlargement and pseudoaneurysm development without clinical manifestations. Intervention is generally reserved for symptomatic, enlarging, or high-risk vascular abnormalities, while the optimal timing of intervention in asymptomatic patients remains uncertain.