Vol 28, No 4 (2022)
Case report
Published online: 2022-12-30
Severe acute kidney injury after pharmacomechanical thrombectomy for acute limb ischemia
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DOI: 10.5603/AA.2022.0016
Acta Angiologica 2022;28(4):166-170.
Abstract
Pharmacomechanical thrombectomy (PMT) with AngioJet (AJ) catheter is one of the most efficacious endovascular
techniques for rapidly removing clots and thrombi from occluded vessels. It has a high technical success
rate but at the cost of hemolysis which may lead to renal damage. Such a complication after AJ has been
published but is still underreported in the literature. In this report, a case of a 68-year-old male patient with
acute limb ischemia (ALI) and severe acute kidney injury (AKI) developed after the use of catheter-directed
thrombolysis (CDT) and PMT AJ has been presented.
Keywords: acute kidney injurypharmacomechanical thrombectomyangiojetcatheter-directed thrombolysisacute limb ischemia
References
- Björck M, Earnshaw JJ, Acosta S, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg. 2020; 59(2): 173–218.
- Karnabatidis D, Spiliopoulos S, Tsetis D, et al. Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol. 2011; 34(6): 1123–1136.
- Rajan DK, Patel NH, Valji K, et al. CIRSE and SIR Standards of Practice Committees, CIRSE and SIR Standards of Practice Committees. Quality improvement guidelines for percutaneous management of acute limb ischemia. J Vasc Interv Radiol. 2005; 16(5): 585–595.
- Fiorucci B, Isernia G, Simonte G, et al. Rheolytic Thrombectomy with AngioJet Is Safe and Effective in Revascularization of Renal Arteries' Acute Occlusion on Previous Complex Aortic Endovascular Repair. Ann Vasc Surg. 2017; 45: 270.e1–270.e6.
- Dukkipati R, Yang EH, Adler S, et al. Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Nat Clin Pract Nephrol. 2009; 5(2): 112–116.
- Arslan B, Turba UC, Matsumoto AH. Acute renal failure associated with percutaneous mechanical thrombectomy for iliocaval venous thrombosis. Semin Intervent Radiol. 2007; 24(3): 288–295.
- Escobar GA, Burks D, Abate MR, et al. Risk of Acute Kidney Injury after Percutaneous Pharmacomechanical Thrombectomy Using AngioJet in Venous and Arterial Thrombosis. Ann Vasc Surg. 2017; 42: 238–245.
- Leung DA, Blitz LR, Nelson T, et al. Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry. J Endovasc Ther. 2015; 22(4): 546–557.
- Morrow KL, Kim AH, Plato SA, et al. Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis. J Vasc Surg. 2017; 65(5): 1460–1466.
- Salem K, Saadeddin Z, Go C, et al. Risk Factors for Acute Kidney Injury After Pharmacomechanical Thrombolysis for Acute Deep Venous Thrombosis. J Vasc Surgery. 2019; 70(2): e18.
- Shen Y, Wang X, Jin SS, et al. Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis. J Vasc Surg Venous Lymphat Disord. 2019; 7(1): 29–37.
- Qian Qi, Nath KA, Wu Y, et al. Hemolysis and acute kidney failure. Am J Kidney Dis. 2010; 56(4): 780–784.
- Khalighi MA, Henriksen KJ, Chang A, et al. Intratubular hemoglobin casts in hemolysis-associated acute kidney injury. Am J Kidney Dis. 2015; 65(2): 337–341.
- Vanholder R, Sever MS, Erek E, et al. Rhabdomyolysis. J Am Soc Nephrol. 2000; 11(8): 1553–1561.
- Currie IS, Wakelin SJ, Lee AJ, et al. Plasma creatine kinase indicates major amputation or limb preservation in acute lower limb ischemia. J Vasc Surg. 2007; 45(4): 733–739.
- Byrne RM, Taha AG, Avgerinos E, et al. Contemporary outcomes of endovascular interventions for acute limb ischemia. J Vasc Surg. 2014; 59(4): 988–995.
- Grip O, Wanhainen A, Michaëlsson K, et al. Open or endovascular revascularization in the treatment of acute lower limb ischaemia. British Journal of Surgery. 2018; 105(12): 1598–1606.
- Ebben HP, Jongkind V, Wisselink W, et al. Catheter Directed Thrombolysis Protocols for Peripheral Arterial Occlusions: a Systematic Review. Eur J Vasc Endovasc Surg. 2019; 57(5): 667–675.
- Kolte D, Kennedy K, Shishehbor M, et al. Endovascular Versus Surgical Revascularization for Acute Limb Ischemia. Circulation: Cardiovascular Interventions. 2020; 13(1).
- Taha AG, Byrne RM, Avgerinos ED, et al. Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. J Vasc Surg. 2015; 61(1): 147–154.