Abstract
BackgroundAngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet® has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJet® thrombectomy and post-procedure developed a stage 3 Acute kidney injury (AKI.) requiring renal replacement therapy (RRT), secondary to intravascular haemolysis. We aim to explore the mechanism and potential risk factors associated with developing AKI in these patients and suggest steps to optimise patient management.Case presentationA 29 year old Caucasian male who developed a stage 3 AKI, requiring RRT, following AngioJet® thrombectomy for an occluded femoral vein stent. Urine and laboratory investigations showed evidence of intravascular haemolysis, which was the likely cause of AKI. Following a brief period of RRT he completely recovered renal function.ConclusionsAKI is an increasingly recognised complication following AngioJet® thrombectomy, but remains underappreciated in clinical practice. AKI results from intravascular haemolysis caused by the device. Up to 13% of patients require RRT, but overall short-term prognosis is good. Pre-procedural risk factors for the development of AKI include recent major surgery. Sodium bicarbonate should be administered to those who develop renal impairment. Renal biopsy is high risk and does not add to management. Increased clinician awareness and vigilance for AKI post-procedure can allow for early recognition and referral to nephrology services for ongoing management.
Highlights
AngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses
acute kidney injury (AKI) results from intravascular haemolysis caused by the device
Up to 13% of patients require renal replacement therapy (RRT), but overall short-term prognosis is good
Summary
AngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. We report the case of a 29 year old patient who underwent AngioJet® thrombectomy and post-procedure developed a stage 3 Acute kidney injury (AKI.) requiring renal replacement therapy (RRT), secondary to intravascular haemolysis. The mechanism of action has been shown to cause significant haemolysis and routinely results in post-procedural haemoglobinuria. This in turn can cause acute kidney injury (AKI), which an increasingly recognized complication of Angiojet®, remains underappreciated in clinical practice. We report the case of a 29 year old male who developed a severe Stage 3 AKI [9], requiring renal replacement therapy (RRT), following AngioJet® thrombectomy of an occluded iliac vein stent. We aim to expand on the possible risk factors for development of AKI in patients undergoing AngioJet®, and suggest steps which could be taken to optimise the management of these patients
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