Complications on the feeding artery after an arterio-venous fistula closure in patients after kidney transplantation - a national cohort study.

Background: Arteriovenous fistulas (AVFs) in kidney transplant recipients are sometimes closed, either as a policy or due to complications. We collected data on the incidence of complications after AVF closure in a national cohort of transplanted patients.

Methods: Patients who received a kidney transplant between 2000 and 2015 and had a functional AVF that was later ligated or extirpated were included. Medical records were searched for arterial complications on the arm with the closed AVF. Furthermore, all patients who were still alive in January 2023 were invited for a follow-up arterial ultrasound exam.

Results: Sixty patients were included; mean follow-up was 9.3 ± 3.8 years. There were five (8% cumulative incidence) patients with symptomatic arterial thrombosis and three (5% incidence) with a symptomatic feeding artery aneurysm. Prospective ultrasound exams were performed in 50 patients; the mean diameter of the brachial artery was almost doubled on the arm with the closed AVF (8.1 ± 3.2 versus 4.7 ± 0.7 mm;  < .001). Additional asymptomatic complications were found in nine patients (18% incidence): seven cases (14% incidence) of arterial thrombosis, some extending up to the axillary artery, and three (6% incidence) brachial artery aneurysms. All patients in whom the thrombosis spread to the brachial artery had large brachial arteries (>10 mm) or an aneurysm.

Conclusion: We observed a high cumulative incidence of arterial thrombosis (20%) and brachial artery aneurysms (10%), sometimes developing several years after AVF closure. These complications should be taken into account when contemplating closure of a well-developed AVF and an AVF-preserving approach with flow reduction surgery might be preferred in some cases.