Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

Background AngioJet[R] is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet[R] has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJe...

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Bibliographic Details
Published in:Journal of medical case reports 2021-09, Vol.15 (1), p.1-459, Article 459
Main Authors: Roper, Tayeba, Amaran, Muhammad, Saha, Prakash, Breen, Cormac, Game, David
Format: Article
Language:English
Subjects:
Abdomen
Acute kidney injury
Analysis
Angiojet
Anticoagulants
Apixaban
Arterial thromboses
Biopsy
Blood tests
Carbonates
Case Report
Case reports
Catheters
Creatinine
Deep vein thromboses
Embolization
Haemolysis
Hemoglobin
Kidneys
Patients
Ultrasonic imaging
Urine
Veins & arteries
Vomiting
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Summary:Background AngioJet[R] is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet[R] has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJet[R] 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 presentation A 29 year old Caucasian male who developed a stage 3 AKI, requiring RRT, following AngioJet[R] 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. Conclusions AKI is an increasingly recognised complication following AngioJet[R] 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. Keywords: Acute kidney injury, Haemolysis, Deep vein thromboses, Arterial thromboses, Angiojet
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-021-03062-3