Prolonged renal failure post-percutaneous mechanical thrombectomy

Percutaneous mechanical thrombectomy (PMT) has been gaining acceptance as a preferred approach for the treatment of acute deep venous thrombosis (DVT). In addition to treating acute DVT and decreasing the risk of pulmonary embolism, it has been reported that direct extraction of the thrombus decreases the risk of post-thrombotic syndrome (PTS), the economic impact of managing which is reported to account for 75% of the total cost of management of DVT patients. PMT combines localized thrombolysis with mechanical thrombectomy. Recently, there have been some reports of reversible acute kidney injury (AKI) occurring post-PMT. The pathophysiology of AKI in such cases is due to hemoglobinuria-associated acute tubular necrosis. Therefore, the overall prognosis of AKI post-PMT has been reported to be good. We report here a case of AKI post-PMT for an extensive DVT of the lower extremity whereby the patient continues to require HD even 5 months after the procedure. The patient had normal renal function prior to the procedure and evidence of hemoglobinuria at the time of diagnosis of AKI. Our case illustrates that patients with a large thrombus load may develop severe AKI post-PMT thus requiring hemodialysis for an extended period of time. Limiting the length of time that the mechanical thrombectomy is performed and quantifying the amount of effluent obtained would appear to be a prudent practice to reduce the risks of renal failure. However, no specific guidelines exist as for the limits of hemolysed exudates to be collected.