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We thank Aydın et al for their comments and questions regarding our manuscript, “Fast-track thrombolysis protocol: A single-session approach for acute iliofemoral deep venous thrombosis,” which was recently presented at the Eastern Vascular Society meeting and is now published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.1Ascher E. Chait J. Pavalonis A. Marks N. Hingorani A. Kibrik P. Fast-track thrombolysis protocol: a single-session approach for acute iliofemoral deep venous thrombosis.J Vasc Surg Venous Lymphat Disord. 2019; 7: 773-780Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar In their response, the authors voice two concerns: acute kidney injury (AKI) after percutaneous mechanical thrombectomy (PMT) and risk of venous thrombosis in stenting across the inguinal ligament. We agree that these are two technical issues that must be addressed in the care of patients with acute iliofemoral deep venous thrombosis, especially those being treated with a single-session approach, such as the fast-track thrombolysis protocol (FTTP).1Ascher E. Chait J. Pavalonis A. Marks N. Hingorani A. Kibrik P. Fast-track thrombolysis protocol: a single-session approach for acute iliofemoral deep venous thrombosis.J Vasc Surg Venous Lymphat Disord. 2019; 7: 773-780Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar AKI is a well-known complication of endovascular procedures involving PMT, probably due to hemolysis induced by the high-pressure saline jets of the rheolytic thrombectomy system as well as the nephrotoxic contrast agents used for angiography. To prevent or to lessen the severity of postoperative AKI, our group wishes to share a few “tips and tricks.” All patients receive perioperative intravenous hydration with crystalloids. Sodium bicarbonate is not used by our group because of a lack of proven efficacy.2Weisbord S.D. Gallagher M. Jneid H. Garcia S. Cass A. Thwin A.A. et al.Outcomes after angiography with sodium bicarbonate and acetylcysteine.N Engl J Med. 2018; 378: 603-614Crossref PubMed Scopus (304) Google Scholar We routinely use <120 seconds of thrombectomy time (or milliliters of recovered aspirate) and always use diluted 50-50 contrast agent mixed with normal saline for each FTTP case. In an attempt to minimize resource and time utilization—a vital aspect of our single-session FTTP—we use the AngioJet (Boston Scientific, Marlborough, Mass) as a nonselective catheter for completion venography. Whereas a transient, subclinical AKI may have occurred in select patients secondary to the nephrotoxic effects of hemolyzed blood products and iodinated contrast material, we did not document the laboratory values in this data set necessary to analyze trends in perioperative renal function. The two patients with known preoperative renal insufficiency did not need hemodialysis. No patients had symptomatic oliguria, hematuria, or electrolyte imbalances that required treatment. Salem et al3Salem K.M. Saadeddin Z. Go C. Eslami M. Hager E. Al-Khoury G. et al.Risk factors for acute kidney injury after pharmacomechanical thrombolysis for acute deep venous thrombosis.September 5-7, 2019Abstract Full Text Full Text PDF Google Scholar identified female sex, bilateral thrombus burden, and a single-stage approach as risk factors for AKI after PMT used in the treatment of DVT. These authors did not include thrombectomy volume or time as part of their analysis. Regarding stent placement into the common femoral vein (CFV), prior literature has suggested that stenting across the inguinal ligament is safe, with satisfactory patency rates for both thrombotic and nonthrombotic lesions.4Neglén P. Tackett Jr., T.P. Raju S. Venous stenting across the inguinal ligament.J Vasc Surg. 2008; 48: 1255-1261Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar However, we tend to avoid stenting of the CFV (our most recent series demonstrated <1.5% CFV stent placement) because of a perceived increase in thrombosis incidence, especially in the obese and those with post-thrombotic syndrome. Because of a lack of intravascular ultrasound utilization for procedures performed in this data set, we did not record the location of each stent placed, nor can we comment on the location of thrombosed stents treated in this study. Whereas a single-stage approach with PMT, thrombolysis, venoplasty, and stenting may seem like an aggressive and cavalier intervention to some classically trained providers, conservative and detail-oriented approaches within the FTTP algorithm can produce effective and safe results for patients without the burden of an intensive care unit stay or an increased risk of bleeding due to prolonged thrombolysis. Complications of iliofemoral deep venous thrombosis treatment with AngioJet pharmacomechanical thrombectomy systemJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 8Issue 3PreviewWe read with interest the article by Ascher et al.1 Acute iliofemoral deep venous thrombosis is a significant cause of cardiovascular morbidity and mortality. Post-thrombotic syndrome is a major complication that results in significant disability and decreased quality of life for approximately half of patients with deep venous thrombosis who receive medical therapy alone.2 Percutaneous pharmacomechanical thrombectomy devices in the venous system have had promising outcomes as an endovascular treatment option for these patients during the last years. Full-Text PDF