Extrarenal arteriovenous fistula. An unusual complication of percutaneous renal transplant biopsy

A percutaneous allograft biopsy in a renal transplant recipient with declining function was followed by haemorrhage from the external iliac artery requiring repair of the puncture site. A common iliac arteriogram performed subsequently showed an external iliac arteriovenous fistula. In retrospect, an isotope scan performed at 48 h post-transplant, showed the upper pole of the graft overlying the iliac vessels. To avoid such complications we recommend a careful assessment of the anatomical relationships of the transplant kidney to major blood vessels prior to biopsy.