Introduction: Interventional treatment of iliofemoral DVT for early clot removal has been shown to reduce the risk of post-thrombotic syndrome. Rheolytic percutaneous mechanical thrombectomy (PMT) utilises saline jets to macerate the thrombus and can reduce lytic dose and exposure compared to catheter directed thrombolysis (CDT) alone. However, haemolysis and haemoglobinuria caused by mechanical thrombus maceration has been associated with an increased risk of acute kidney injury (AKI). This study sought to evaluate the risk of renal injury amongst patients receiving PMT relative to those who received catheter directed thrombolysis (CDT) alone. Methods: A retrospective cohort study examining all patients who presented to a vascular tertiary centre between 2011 and 2017 and received catheter-directed thrombolysis, with or without percutaneous mechanical thrombectomy, for treatment of symptomatic acute ilio-femoral DVT. Patient demographics, thrombosis risk factors, modality of treatment and incidence of complications were collected. The renal function of these patients was assessed through their pre-procedural eGFR and creatinine, the acute effect with peak creatinine within 72hrs of percutaneous intervention, and recovery with highest baseline eGFR in the subsequent 6 months. KDIGO (Kidney Disease Improving Global Outcomes) criteria were used to determine the presence and severity of acute renal dysfunction, and CKD (chronic kidney disease) classification was used to categorize the extent of long-term renal impairment. Results: A total of 139 patients, 63 (45%) treated with PMT vs. 76 (55%) treated with CDT alone, were identified. Baseline demographic data and prevalence of risk factors were comparable. On admission, 36 cases overall (26%) were identified to have an eGFR of less than 70. The mean rise in creatinine observed within 72hrs of the procedure was not significantly different: PMT 1.24 times (95%CI:1.11-1.37), vs. CDT 1.08 times (95%CI:0.88-1.29) pre-procedural values (p=0.48). However, there was an observed difference in the number of patients who developed stage 1 AKI or above, 14% (n=8) of patients receiving PMT compared to 3% (n=2) receiving CDT (p=0.04). Observed difference in development of AKI stage 2 or more was not significant (p=0.14). The majority of patients (82% of PMT cases vs. 86% of CDT) were observed to return to baseline eGFR within 6 months, with 69% vs. 70% recovering within 14 days. Post-procedurally 57% PMT vs. 43% CDT cases were classified with a renal impairment of at least CKD stage 2 (p=0.18). Conclusion: Use of PMT was associated with a greater transient rise in serum creatinine and stage 1 AKI or above, but no difference was observed in return to baseline renal function. Interestingly, patients presenting with iliofemoral DVT appear at risk of renal impairment regardless of treatment modality. These findings warrant further mechanistic evaluation. Disclosure: Cook, BSCI, Optimed, Bard, Medtronic, Vesper, Veniti, Philips-Volcano, BTG