Endovascular treatment of arteriovenous fistulas complicating percutaneousrenal biopsy in three paediatric cases

Design. We evaluated the incidence and history of arteriovenous fistula (AV F) after kidney biopsy and assessed the use of superselective embolization for treatment. Observations. During the last 10 years, 896 kidney biopsies (age range of t he patients: 1 month-18.6 years) have been performed in our institution und er real-time ultrasonographic guidance with a 14 gauge cutting biopsy needl e, and 32 of the patients had renal allografts (3.4%). We observed three ca ses of AVF (two in allograft kidneys, one in a native kidney) among all bio psies (0.34%), and the incidence of developing AVF after renal allograft bi opsy was 6.3%. All three patients with AVF were symptomatic, and intravascu lar therapy was indicated. Interventions. An angiographic study combined with endovascular treatment o f the intrarenal AVF and pseudoaneurysm was performed in all three patients . Embolization was performed with bucrylate and lipiodol in two patients an d with micro-coils in one. After successful embolization, all three patient s became asymptomatic tin two renal bleeding stopped, in one patient with s evere 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 ca theter is an effective and safe method in the treatment of post-biopsy AVFs and pseudoaneurysm.