Management of an aneurysmal arteriovenous fistula in kidney transplant recipients

Transplant Rev (Orlando). 2023 Dec;37(4):100799. doi: 10.1016/j.trre.2023.100799. Epub 2023 Sep 29.


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.

Keywords: Aneurysm; Arteriovenous fistula; Renal transplantation; Vascular access.

Publication types

  • Review

MeSH terms

  • Arteriovenous Fistula* / etiology
  • Arteriovenous Fistula* / surgery
  • Arteriovenous Shunt, Surgical* / adverse effects
  • Humans
  • Kidney Failure, Chronic* / surgery
  • Kidney Transplantation* / adverse effects
  • Renal Dialysis
  • Transplant Recipients
  • Treatment Outcome