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Management of an aneurysmal arteriovenous fistula in kidney transplant recipients

M. Corr, K. Lawrie, P. Baláž, S. O'Neill

. 2023 ; 37 (4) : 100799. [pub] 20230929

Language English Country United States

Document type Journal Article, Review

Persistent link   https://www.medvik.cz/link/bmc24000438

Aneurysms remain the most common complication of an arteriovenous fistula created for dialysis access. The management of an aneurysmal arteriovenous fistula (AAVF) in kidney transplant recipients remains contentious with a lack of clear clinical guidelines. Recipients of a functioning graft do not require the fistula for dialysis access, however risk of graft failure and needing the access at a future date must be considered. In this review we outline the current evidence in the assessment and management of a transplant recipient with an AAVF. We will describe our recommended five-step approach to assessing an AAVF in transplant patients; 1.) Define AAVF 2.) Risk assess AAVF 3.) Assess transplant graft function and future graft failure risk 4.) Consider future renal replacement therapy options 5.) Vascular mapping to assess future vascular access options. Then we will describe the current therapeutic options and when they would most appropriately be employed.

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$a Corr, Michael $u Centre of Public Health - Queen's University Belfast, Belfast, United Kingdom; Regional Nephrology & Transplant Unit-Belfast Health and Social Care Trust, Belfast, United Kingdom. Electronic address: Michael.corr@qub.ac.uk
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$a Aneurysms remain the most common complication of an arteriovenous fistula created for dialysis access. The management of an aneurysmal arteriovenous fistula (AAVF) in kidney transplant recipients remains contentious with a lack of clear clinical guidelines. Recipients of a functioning graft do not require the fistula for dialysis access, however risk of graft failure and needing the access at a future date must be considered. In this review we outline the current evidence in the assessment and management of a transplant recipient with an AAVF. We will describe our recommended five-step approach to assessing an AAVF in transplant patients; 1.) Define AAVF 2.) Risk assess AAVF 3.) Assess transplant graft function and future graft failure risk 4.) Consider future renal replacement therapy options 5.) Vascular mapping to assess future vascular access options. Then we will describe the current therapeutic options and when they would most appropriately be employed.
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$a Lawrie, Kateřina $u Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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$a Baláž, Peter $u Division of Vascular Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Cardiocenter, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovak Republic
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$a O'Neill, Stephen $u Regional Nephrology & Transplant Unit-Belfast Health and Social Care Trust, Belfast, United Kingdom; Centre of Medical Education, Queen's University Belfast, Belfast, United Kingdom
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