Rescue From Permanent Kidney Injury in Acute Thrombosis of Both Renal Veins, the Inferior Vena Cava, and Both Iliofemoral Veins by Catheter-Based Thrombectomy

Author:

Hofer Felix1,Mueller Jan2,Copic Dragan2,Eichinger-Hasenauer Sabine3,Kinstner Christian4,Reider Lukas4,Merrelaar Marieke5,Korn Stephan6,Bauer Wolfgang7,Koppensteiner Renate8,Aschauer Constantin2,Sunder-Plassmann Gere2,Schmidt Alice2,Schlager Oliver8ORCID

Affiliation:

1. Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria

2. Division of Nephrology, Department of Medicine III, Medical University of Vienna, Vienna, Austria

3. Division of Hematology and Hemostasis, Department of Medicine I, Medical University of Vienna, Vienna, Austria

4. Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria

5. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria

6. Department of Urology, Medical University of Vienna, Vienna, Austria

7. Department of Dermatology, Medical University of Vienna, Vienna, Austria

8. Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria

Abstract

Case: A 33-year-old man with previously diagnosed lupus membranous nephropathy presented with painful swelling in both legs. Laboratory tests revealed acute kidney injury, and imaging studies by duplex ultrasound and computed tomography scan showed acute thrombosis of both renal veins, the infrahepatic inferior vena cava, and both iliofemoral venous segments. Initially, pharmacomechanical thrombolysis led to an insufficient morphological result. The therapeutic breakthrough was achieved by catheter-based mechanical thrombectomy of the infrarenal vena cava and both renal veins, which successfully cleared all affected venous segments from thrombus, paralleled by improvement of the patient’s condition. However, after 1 week, the patient experienced recurrent thrombosis of the right renal vein with hemorrhagic infarction of the right kidney. After further optimization of immunomodulatory and antithrombotic therapy, a repeated catheter-based mechanical thrombectomy resulted in sustained clinical improvement and preservation of renal venous drainage and kidney function. Conclusion: Extensive acute thrombosis of both renal veins, the inferior vena cava, and both iliofemoral venous segments is a rare emergency potentially threatening kidney function. Immediate effective thrombus removal is essential to preserve kidney function and can be achieved by catheter-based mechanical thrombectomy embedded in a comprehensive immunomodulatory and antithrombotic therapeutic concept. Clinical Impact This case demonstrated the efficacy of a catheter-based therapeutic approach in patients with extensive thrombosis of the venous system. A catheter-based approach must be embedded in a comprehensive medical therapeutic concept, which is essential to achieve a sustainable result.

Publisher

SAGE Publications

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