Acute thromboembolism in a solitary kidney: revascularization by means of isolated transcatheter thrombus aspiration

Abstract

Acute renal infarction occurs usually secondary to thromboembolism rather than in situ thrombosis, with atrial fibrillation being the main predisposing factor. Its non-specific presentation, being similar to renal colic and pyelonephritis, often leads to diagnostic and treatment delays. Prompt diagnosis and treatment are crucial for the outcome, as the precise therapeutic window remains unclear. Renal Doppler ultrasound is the optimal initial diagnostic study, which, if inconclusive, should be followed by contrast-enhanced CT. Despite the lack of specific guidelines, treatment is mainly based on anticoagulation and percutaneous endovascular revascularization therapy; the latter includes pharmacomechanical thrombectomy; intra-arterial thrombolysis alone or in combination with thrombus aspiration; and angioplasty, with or without stenting. We present a case of renal thromboembolism diagnosed early during the postoperative period in a patient with a single functioning kidney. Renal arterial flow restoration was achieved by means of transcatheter thrombus aspiration. This is the first report showing the effectiveness of this procedure alone as an alternative to those used so far.