Catheter-directed Thrombolytic Therapy Research Articles

Application of the Double Series Filter Technique for the Treatment of Acute Inferior Vena Cava Filter-Mediated Thrombosis

In this study, we examined the safety and effectiveness of removing inferior vena cava (IVC) filters with residual acute thrombosis after endovascular therapy. A retrospective chart review of 712 patients who underwent retrievable IVC filter implantation between July 2018 and December 2022 was conducted. Residual thrombosis with the IVC filter occurred in 18 patients, and the volume of residual acute thrombosis in the IVC filter exceeded 1mL in all cases. Angiography was performed to evaluate the size of the residual thrombosis and its position with respect to the filter. The double series filter technique (first filter, infrarenal IVC filter; second filter, suprarenal IVC filter) was used to remove the filter and thrombosis. We summarize the diagnosis, treatment, and surgical experience of these patients. In this study, 16 of 18 patients (88.9%) demonstrated residual thrombosis in the IVC filter. One patient (5.6%) demonstrated thrombosis located both inside and floating above the filter, and one patient (5.6%) demonstrated thrombosis located both inside and underneath the filter. The technical success rate of double series IVC filter retrieval was 100%. Seventeen patients (94.4%) underwent single-stage suprarenal IVC filter retrieval, and one patient (5.6%, 1/18) underwent two-stage retrieval. In terms of residual thrombosis removal, 14 patients (77.7%) achieved complete removal and 4 patients (22.3%) achieved partial removal. Residual thrombosis could not be removed through the sheath in one patient, so femoral vein thrombectomy was performed. No other procedure-related complications were observed. The median follow-up time was 22.5±6.8months. No recurrence of thrombus symptoms was reported, and B ultrasound and computed tomography demonstrated smooth blood flow in the IVC, renal veins, and pulmonary artery. For patients with residual acute thrombosis on the IVC filter and in whom there was absence of a more appropriate treatment after percutaneous mechanical thrombectomy or catheter-directed thrombolysis therapy, the double series IVC filter technique was a safe approach to improve the IVC filter retrieval rate in the early stage, as well as for simultaneous residual thrombus removal.

In silico assessment of histotripsy-induced changes in catheter-directed thrombolytic delivery.

Introduction: For venous thrombosis patients, catheter-directed thrombolytic therapy is the standard-of-care to recanalize the occluded vessel. Limitations with thrombolytic drugs make the development of adjuvant treatments an active area of research. One potential adjuvant is histotripsy, a focused ultrasound therapy that lyses red blood cells within thrombus via the spontaneous generation of bubbles. Histotripsy has also been shown to improve the efficacy of thrombolytic drugs, though the precise mechanism of enhancement has not been elucidated. In this study, in silico calculations were performed to determine the contribution of histotripsy-induced changes in thrombus diffusivity to alter catheter-directed therapy. Methods: An established and validated Monte Carlo calculation was used to predict the extent of histotripsy bubble activity. The distribution of thrombolytic drug was computed with a finite-difference time domain (FDTD) solution of the perfusion-diffusion equation. The FDTD calculation included changes in thrombus diffusivity based on outcomes of the Monte Carlo calculation. Fibrin degradation was determined using the known reaction rate of thrombolytic drug. Results: In the absence of histotripsy, thrombolytic delivery was restricted in close proximity to the catheter. Thrombolytic perfused throughout the focal region for calculations that included the effects of histotripsy, resulting in an increased degree of fibrinolysis. Discussion: These results were consistent with the outcomes of in vitro studies, suggesting histotripsy-induced changes in the thrombus diffusivity are a primary mechanism for enhancement of thrombolytic drugs.

Retracted: Solitaire™ Stent Thrombectomy System in the Treatment of Acute Lower-Limb Ischemia: Comparisons in Safety and Effectiveness with Conventional Catheter-Directed Thrombolysis Therapy.

[This retracts the article DOI: 10.1155/2022/6997221.].

Treating a limb-threatening arterial clot in a newborn with catheter-directed thrombolysis.

Non-catheter related arterial thromboembolism in the neonatal population is rare and carries a significant risk of organ damage or limb loss. Thrombolysis, whether systemic or catheter- directed, is reserved either for limb or life-threatening thrombosis due to risk of bleeding especially in premature neonates. In this case, an infant male born at 34weeks and 4days gestational age presented with limb-threatening clot in the distal right subclavian artery and proximal right axillary artery with no known cause. After discussion of risks and benefits of various treatment options, he received thrombolysis treatment with low dose recombinant TPA via an umbilical artery catheter. There was complete resolution of the thrombus with this treatment and the patient had no significant bleeding while receiving treatment. Further investigation is needed to identify the patient population that will benefit from catheter-directed thrombolytic therapy and how to best monitor these patients.

ClotTriever system for mechanical thrombectomy of deep vein thrombosis.

There is increasing evidence that early and comprehensive removal of thrombus in deep vein thrombosis is associated with improved outcomes, including decreased incidence of post-thrombotic syndrome and debilitating long-term symptoms. Catheter-directed thrombolysis is effective for the rapid removal of clot, but it is associated with high bleeding risk. Percutaneous mechanical thrombectomy is a highly effective method for the removal of clot without the use of systemic or catheter-directed thrombolytic therapy. The Inari ClotTriever system (Inari Medical Inc., CA, USA) is a thrombectomy device, which is approved for deep vein thrombosis by the US FDA in 2017. Herein we review the current treatment strategies using the ClotTriever system, its specifications, indications and current state of literature.

Abstract 11239: Gender Disparities in the Utilization of Catheter-Directed Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism

Introduction: Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before. Methods: Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy. Results: We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value - .03). Males were more likely to have saddle PE (33% vs. 29%, p-value < .01) and less likely to have vasopressor use (3% vs. 5%, p-value < .01). Baseline characteristics are shown in Table 1. Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value < .01), as shown in Table 2. Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value < .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value < .01). Conclusion: Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.

Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy

BackgroundPortomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient’s clinical details, radiological findings, safety, and efficacy are reported.Cases presentationTwo patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery.ConclusionPMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.

Solitaire™ Stent Thrombectomy System in the Treatment of Acute Lower-Limb Ischemia: Comparisons in Safety and Effectiveness with Conventional Catheter-Directed Thrombolysis Therapy.

Objective The study aimed to investigate the safety and efficacy of the Solitaire™ AB Stent System (ev3 Inc., Plymouth, MN, USA) for the treatment of acute lower extremity ischemia (ALLI) compared with conventional catheter-directed thrombolytic therapy. Methods Retrospective analysis of patients with ALLI treated in the Department of Interventional Radiology at the First Hospital of Nanjing from January 2017 to April 2020 divided into a conventional (CDT) group (n = 106) and a percutaneous mechanical thrombectomy (PMT) group (n = 55) according to the procedure. PMT was performed using the Solitaire™ AB stent system. The combined clinical outcomes of mortality, major amputation, recurrent ischemia, and major morbidity were compared between the two groups. Results Of the 161 patients, 128 (79.5%) did not have a composite clinical outcome after 12 months of follow-up, namely, 78 CDT patients and 50 PMT patients, with significant differences in composite clinical outcome (26.4% vs. 9.1%, P = 0.010) and mortality (19.8% vs. 7.3%, P = 0.037) between them. Thrombolytic drug dose (19.34 ± 5.93 vs. 13.55 ± 6.54 mg, P < 0.001) and length of hospital stay (8.29 ± 3.91 vs. 5.49 ± 1.18 days, P = 0.003) were significantly lower in the PMT group. Conclusion PMT with the Solitaire™ AB Stent System is safer and more effective in treating patients with Rutherford stage I-IIB ALLI, with the advantage of rapid opening of obstructed vessels, shorter thrombolysis time, reduced thrombolytic dose, and improved blood flow to the infrapopliteal vessels.

Catheter-directed thrombolytic therapy for lowerextremity deep vein thrombosis: a case report

Globoka venska tromboza spodnjih okončin je pogost razlog za obravnavo bolnika v urgentni ambulanti. Kljub temu so napredovale oblike globoke venske tromboze redke (npr. phlegmasia cerulea dolens). Lokalna katetrska tromboliza velja za terapijo izbora pri zdravljenju napredovalih oblik globoke venske tromboze, kot je phlegmasia cerulea dolens. V članku bomo predstavili prvi primer tovrstnega zdravljenja v Univerzitetnem kliničnem centru Maribor (UKC Maribor).

Early Diagnosis and Intervention of Acute Renal Infarction with Catheter-Directed Thrombolytic Therapy.

Acute renal infarction is a rare and under-diagnosed disease for which the optimal treatment is unknown. This study aimed to determine the utility of catheter-directed thrombolysis (CDT) to treat acute renal infarction. From November 2010 to September 2017, 13 patients with acute renal infarction were treated with CDT. The diagnosis was confirmed by contrast-enhanced computed tomography and renal angiography. The most common symptoms and signs were flank pain (53.8%) and abdominal pain (30.8%). More than two-thirds of the patients (69.2%) had atrial fibrillation. In successful reperfusion cases, the median time from symptom onset to diagnosis was 6 hours, and the average time from diagnosis to treatment was 3.5 hours. Complete resolution of thrombi in the renal artery was achieved in 10 of the 13 patients (76.9%) and partial resolution in two patients (15.4%). Only one patient (7.7%) failed to respond to treatment. Compared with admission, renal function was significantly improved at 6 months. No major complications occurred during the course of CDT therapy. CDT offers an alternative to surgical intervention and can achieve good angiographic results with an early diagnosis and intervention. It is relatively safe and can restore at least partial renal function.

Endovasküler Yöntemlerle Tedavi Ettiğimiz Akut Alt Ekstremite Emboli Deneyimlerimiz

Objectives: The study aims to retrospectively evaluate the 1-year results of endovascular treatment with rheolytic thrombectomy(TR) or catheter-directed thrombolytic(CDT) infusion therapy in acute femoro-popliteal bypass graft occlusion.&#x0D; Methods: The patients who had a history of femoro-popliteal by-pass operation and during their follow-up diagnosed with ipsilateral acute limb ischemia between 2016 and 2018 were included. The total of 13 patients were included and they were divided into two groups according to their treatment methods (RT, n=8 vs CDT, n=5).&#x0D; Results: There was no statistically significant difference between the two groups in terms of demographic data and Rutherford embolism classification. Reolitic thrombectomy and catheter-directed thromolytic infusion primary patency values were 87.5% and 80% for 6 months, 75% and 60% for 12 months, respectively. Secondary patency values were found to be 100% in both groups for 6 months, and 87.5% and 80% for 12 months, respectively. There was no significant difference between the two groups in terms of primer and sekonder patency.&#x0D; Conclusion:Endovascular therapy can be preferred in the treatment of acute femoro-popliteal by-pass graft occlusion in selected patient groups due to its less invasiveness, early mobilization, and low mortality and morbidity rates compared to surgery,

(More than) doubling down: Effective fibrinolysis at a reduced rt-PA dose for catheter-directed thrombolysis combined with histotripsy.

Deep vein thrombosis is a major source of morbidity and mortality worldwide. For acute proximal deep vein thrombosis, catheter-directed thrombolytic therapy is an accepted method for vessel recanalization. Thrombolytic therapy is not without risk, including the potential for hemorrhagic bleeding that increases with lytic dose. Histotripsy is a focused ultrasound therapy that generates bubble clouds spontaneously in tissue at depth. The mechanical activity of histotripsy increases the efficacy of thrombolytic therapy at doses consistent with current pharmacomechanical treatments for venous thrombosis. The objective of this study was to determine the influence of lytic dose on histotripsy-enhanced fibrinolysis. Human whole blood clots formed in vitro were exposed to histotripsy and a thrombolytic agent (recombinant tissue plasminogen activator, rt-PA) in a venous flow model perfused with plasma. Lytic was administered into the clot via an infusion catheter at concentrations ranging from 0 (control) to 4.54 μg/mL (a common clinical dose for catheter-directed thrombolysis). Following treatment, perfusate samples were assayed for markers of fibrinolysis, hemolysis, and intact red blood cells and platelets. Fibrinolysis was equivalent between the common clinical dose of rt-PA (4.54 μg/mL) and rt-PA at a reduction to one-twentieth of the common clinical dose (0.23 μg/mL) when combined with histotripsy. Minimal changes were observed in hemolysis for treatment arms with or without histotripsy, potentially due to clot damage from insertion of the infusion catheter. Likewise, histotripsy did not increase the concentration of red blood cells or platelets in the perfusate following treatment compared to rt-PA alone. At the highest lytic dose, a refined histotripsy exposure scheme was implemented to cover larger areas of the clot. The updated exposure scheme improved clot mass loss and fibrinolysis relative to administration of lytic alone. Overall, the data collected in this study indicate the rt-PA dose can be reduced by more than a factor of ten and still promote fibrinolysis when combined with histotripsy.

Response Team Management of Acute Serious Pulmonary Embolism.

Response Team Management of Acute Serious Pulmonary Embolism.

Catheter-directed thrombolysis for deep vein thrombosis: 2021 update.

Catheter-directed thrombolysis (CDT) has been utilized as an adjunct to anticoagulant therapy in selected patients with deep vein thrombosis (DVT) for approximately 30 years. CDT used to be limited to patients with DVT causing acute limb threat and those exhibiting failure of initial anticoagulation, but has expanded over time. Randomized trials evaluating the first-line use of CDT for proximal DVT have demonstrated that CDT does not produce a major reduction in the occurrence of post-thrombotic syndrome (PTS) and that it is poorly suited for elderly patients and those with limited thrombus extent or major risk factors for bleeding. However, CDT does offer selected patients with acute iliofemoral DVT improvement in reducing early DVT symptoms, in achieving reduction in PTS severity, and in producing an improvement in health-related quality of life (QOL). Clinical practice guidelines from medical and surgical societies are now largely aligned with the randomized trial results. This review offers the reader an update on the results of recently completed clinical trials, and additional guidance on appropriate selection of patients with DVT for catheter-directed thrombolytic therapy.

Evaluation of Catheter Directed Thrombolytic Therapy versus Systemic Anticoagulant Therapy of Acute Ilio-Femoral Deep Vein Thrombosis

Abstract Background Deep venous thrombosis (DVT) is a major cause of morbidity and mortality all-over the world. Complications include pulmonary embolism (PE), post-thrombotic syndrome (PTS), phlegmasia alba dolens, phlegmasia cerulea dolens and venous gangrene. The PTS is the most common cause of long-term morbidity and disability among the previous complications. Aim of the Work The aim of this work is evaluation of the regional catheter-directed thrombolytic therapy versus standard systemic anticoagulant therapy in cases of acute ilio-femoral deep vein thrombosis as regard to efficacy, safety as well as complications. Patients and Methods This study was conducted on 30 patients presented to the vascular surgery unit of Ahmed Maher Teaching Hospital between February, 2019 and August, 2019 with acute iliofemoral deep venous thrombosis (less than two weeks duration). Of the 30 patients, 18 were females and 12 were males. The age of the patients ranged between 22 and 55 years. Results The outcome results of early Follow up of the thrombolytic therapy was complete recanalization in 30.7% of the cases, partial re-canalization in 53.8% of the cases and poor recanalization in the remaining cases15.3%.While the follow up results of anticoagulant therapy was complete re-canalization in 6.7% of the cases, partial re-canalization in 60% of cases and poor recanalization in the remaining cases 33.3% Conclusion Catheter directed thrombolytic therapy using streptokinase, as a lytic agent in the treatment of acute ilio-femoral DVT is a safe and efficient technique.

Pulmonary Embolism in Pregnancy: Ultrasound-Assisted Catheter-Directed Thrombolytic Therapy for the Treatment of a Pulmonary Embolus—A Case Report

Abstract In the United States, pulmonary embolism (PE) accounts for approximately 10% of all pregnancy related deaths. The standard treatment for a patient with high-risk PE is systemic thrombolysis. Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications, including spontaneous abortion, preterm delivery, and fetal bleeding. Currently, there is limited evidence for a standardized approach for the treatment and management of intermediate- and high-risk PEs in pregnancy. A 36-year-old gravida 3 para 2002 woman at 31+1 weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath. A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches. A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function. The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis. She subsequently delivered a healthy male infant at term. Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited. Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy. Catheter-directed thrombolysis can be efficacious in treating intermediate- and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.

Potential risk during catheter-directed thrombolytic therapy for pulmonary embolism and how to avoid it

Pulmonary embolism (PE) remains one of the highest causes of cardiovascular mortality worldwide. Systemic thrombolysis for acute PE reduces cardiovascular collapse but has the potential to cause major complications, including intracranial hemorrhage, systemic hemorrhage, immunologic complications, hypotension, and myocardial rupture. Catheter-directed thrombolysis accompanied with high-frequency ultrasound reduces systemic dose, allows increased local dose, and expedites clot lysis at the site of embolism. Although rare, some patients may have a patent foramen ovale or other atrial septal defect (ASD) which cannot be visualized during fluoroscopy which may complicate this procedure. A 41-year-old diabetic smoker presented to the emergency department with hypoxia, tachycardia, and light headedness. Computed tomography angiography (CTA) of the chest revealed bilateral PE with right ventricular enlargement and right heart strain pattern. Transthoracic echocardiogram revealed right ventricular enlargement. He was diagnosed with submassive PE. He underwent right heart catheterization with two angled pigtail catheters manipulated through the right heart to reach the right and left pulmonary arteries, however on frontal fluoroscopy, the catheters appeared slightly more caudal than would be expected. Lateral fluoroscopy was performed which did not show the catheter going through the expected anterior curvilinear course of the right ventricle and pulmonary trunk. Contrast was injected into each pigtail catheter and this demonstrated retrograde flow of contrast back into the left atrium, confirming that the catheters were positioned in the pulmonary veins, having passed through an ASD. On review of CTA chest, there was a visible patent foramen ovale. Congenital heart defects are rare but can complicate certain procedures and interventionalists need to be aware of this possibility. Catheter position more caudal than the pulmonary artery silhouettes should alert the operator to the incorrect placement in the pulmonary veins through an ASD. In these circumstances, lateral fluoroscopy will show absence of the catheters along the expected anterior curvilinear route of the right ventricle, pulmonary infundibulum, and pulmonary trunk. Contrast injection will show centripetal flow back to the left atrium rather than the centrifugal flow away from the heart. Other potential confirmatory methods include pressure monitoring and blood gas sampling. In addition, careful scrutiny of the CT angiogram for an ASD before the procedure may alert the operator to this potential pitfall. The interventionalist must remain vigilant to unexpected anatomical variants to avoid potential harm.

Anuria as a Chief Presentation of Takayasu Arteritis, a Case Report

Takayasu vasculitis is a rare type of large vessel vasculitis that primarily affects the aorta and its main branches; signs and symptoms are usually due to systemic inflammation or ischemia of an organ or limb, depending on the group of blood vessels involved. In addition, Takayasu arteritis is associated with increased platelet and coagulation activity, leading to a hypercoagulable state and thrombus formation. We report a case of a 47-year-old male who presented with a history of complete anuria for 3 days and was found to have progressively worsening kidney function. Renal Doppler ultrasound confirmed the presence of bilateral renal artery thrombosis, while Contrast- Enhanced Computed Tomography (CECT) of the abdomen and pelvis showed extensive abdominal aortic thrombosis with radiological findings consistent with large vessel vacuities. After catheter-directed thrombolytic therapy of the renal arteries, the patient started producing urine and his kidney function significantly improved. Later, Positron Emission Tomography scan (PET) confirmed large vessel Takayasu arteritis. Echocardiography showed no intracardiac thrombus, along with an extensive work up for thrombophilia, as autoimmune and vasculitis serology came back negative. This is an extremely rare presentation of Takayasu arteritis, with an unusual recovery of acute renal failure after delayed anuria due to bilateral renal artery thrombosis.

Current Concepts in the Diagnosis and Management of Pulmonary Embolism

Acute pulmonary embolism (PE) is one of the most common causes of cardiovascular death. Most often acute PE is associated with under diagnosis, misdiagnosis and delay in diagnosis and management leading to high morbidity and mortality. PE outcomes will improve with proper evaluation of clinical symptoms and signs, relevant diagnostic tests, identifying high-risk patients suitable for early re-perfusion with I.V. or catheter-directed thrombolytic therapy or surgical embolectomy and in some cases additional use of mechanical circulatory support. During clinical evaluation modified Geneva score, Well’s score, and Simplified pulmonary embolism severity index (sPESI) scores are useful in assessing PE and its adverse outcomes. Hestia criteria are useful in identifying suitable for outpatient management of PE. Long-term management of PE involves identifying patients prone for recurrence and CTPE with appropriate long-term prophylaxis using oral anticoagulants.

Anuria as a Chief Presentation of Takayasu Arteritis

Takayasu vasculitis is a rare type of large vessel vasculitis that primarily affects the aorta and its main branches; signs and symptoms are usually due to systemic inflammation or ischemia of an organ or a limb, depending on the group of blood vessels involved. In addition, Takayasu arteritis is associated with increased platelet and coagulation activity, leading to a hypercoagulable state and thrombus formation. We report a case of a 47-year-old male who presented with a history of complete anuria for 3 days and was found to have progressively worsening kidney function. Renal Doppler ultrasound confirmed the presence of bilateral renal artery thrombosis, while contrast-enhanced computed tomography (CECT) of the abdomen and pelvis showed extensive abdominal aortic thrombosis with radiological findings consistent with large vessel vacuities. After catheter-directed thrombolytic therapy of the renal arteries, the patient started producing urine and his kidney function significantly improved. Later, positron emission tomography scan (PET) confirmed large vessel Takayasu arteritis. Echocardiography showed no intracardiac thrombus, along with an extensive work-up for thrombophilia, as autoimmune and vasculitis serology came back negative. This is an extremely rare presentation of Takayasu arteritis, with an unusual recovery of acute renal failure after prolonged anuria due to bilateral renal artery thrombosis.