Pharmacomechanical aspiration thrombectomy of iliofemoral deep venous thrombosis to salvage the transplanted kidney - A case report

Abstract

Ipsilateral acute iliofemoral deep venous thrombosis (DVT) after a renal transplantation, although rare, has a high morbidity, causing complications such as allograft failure, rupture, or death. Treatment modalities are limited due to the risk of bleeding and impaired renal function. We report successful treatment of a case of iliofemoral DVT in a 58-year-old male recipient of a living donor renal transplantation. The immediate postoperative course of the patient was uneventful, and he was discharged on 6th postoperative day (POD) with serum creatinine of 0.8 mg/dl. On POD 26, the patient was admitted with diarrhea, dehydration, and decreased urine output. His serum creatinine rose from 0.8 mg/dl to 2.6 mg/dl and he developed pain and swelling of the right lower extremity. Duplex ultrasonography was suggestive of acute DVT with noncompressible right distal external iliac vein, common femoral, superficial femoral and popliteal veins, absence of color flow from the right femoral vein to the common iliac vein, dilatation of allograft renal vein and an increased renal graft resistive index of 0.97. After inferior vena cava filter insertion, initial treatment with percutaneous balloon angioplasty and catheter-directed thrombolysis could not restore blood flow. Subsequently, percutaneous transluminal pharmacomechanical aspiration was performed with complete removal of the thrombus leading to restored renal allograft vein patency and normalization of allograft function and Duplex findings.

Keywords

• dvt
• percutaneous aspiration thrombectomy (pharmacomechanical aspiration thrombectomy-angiojet®)
• renal vein thrombosis