Risk of Acute Kidney Injury with Intervention for Acute Deep Venous Thrombosis

Abstract

The treatment of acute deep venous thrombosis (DVT) continues to evolve. Whereas catheter-directed thrombolysis with mechanical thrombectomy has been used to treat patients successfully, such treatment regimens carry an inherent risk of nephropathy that has yet to be quantified. The goal of this study was to determine the risk of acute kidney injury in patients treated for acute DVT with mechanical thrombectomy and lysis. A retrospective review of prospectively collected data was conducted for 152 patients presenting to the two hospitals in Albany, New York, where lysis is performed by the Vascular Group, a large single-specialty vascular surgery group composed of board-certified vascular surgeons. Data collection included demographics, preprocedural and postprocedural creatinine concentration and glomerular filtration rate (GFR), number of interventions within the acute episode, total contrast material dose, adjuvant procedures, and anatomic location of the DVT. All interventions were performed by vascular surgeons adept at evaluation and endogenous treatment. Decisions about initiation of therapy and method of intervention were made at the discretion of the treating surgeons. During 5 years (2012-2017), 152 patients underwent intervention for treatment of acute DVT. Group 1 included 144 patients who had no significant periprocedural renal changes. Group 2 had eight patients with changes in renal function periprocedurally. Mean age, number of procedures, anatomic location of the DVT, and contrast material dose were similar in the two groups. Patients in group 2 did have both a higher baseline creatinine concentration (0.87 vs 1.35 mg/dL; P = .03) and lower GFR (58.6 vs 48.3 mL/min/1.73 m2; P = .046). Patients with abnormal GFR were more likely to have periprocedural renal impairment (P = .0023). The addition of mechanical thrombectomy to any procedure conferred an increased risk of acute renal impairment (P = .039). No patient required permanent hemodialysis, although two patients with normal initial renal function required temporary hemodialysis after intervention. This study represents initial evidence that for patients undergoing intervention for acute DVT, there is a small (5.2%) but real risk of temporary periprocedural renal impairment. Predisposing factors in the study are limited to impaired renal function at admission, although normal renal function is not completely protective. Renal tubular necrosis may complicate mechanical thrombectomy and augment the risk of nephropathy posed by the use of iodinated contrast agents. Whereas intervention for acute DVT can be safely undertaken, additional investigation is necessary to clarify what specific elements of mechanical thrombectomy pose the greatest risk to patients and how that risk may best be mitigated in the future.