Effects on Renal Function After Percutaneous Mechanical Thrombectomy Using AngioJet

Abstract

Objectives: Percutaneous mechanical thrombectomy (PMT) is a popular and useful tool for thrombus removal in acute thrombotic syndromes. The AngioJet uses high-pressure spray to break up and aspirate thrombus in addition to delivering plasminogen activators. This is known to cause hemolysis, and all practitioners have noted periprocedural hematuria. Despite this, to our knowledge, there is no study evaluating the consequences to renal function after using this device. We sought to determine the incidence of acute kidney injury, and associated risk factors after using the AngioJet for thrombolysis.Methods: With Investigational Review Board approval, we retrospectively reviewed a prospectively maintained database of all patients managed by the vascular surgery service from 2009-2012 with procedural codes describing thrombolysis (Current Procedural Terminology [CPT] codes 37201, 37187, 37209, and 75898), and/or PMT (CPT 37187). We identified those treated with the AngioJet and reviewed demographics, indications, laboratory values before and after the procedure (up to 3 days), and determined the incidence of acute kidney injury (AKI). AKI was defined as an increase in creatinine (Cr) >25% of baseline within 24 to 72 hours. Patients on dialysis before AngioJet or without laboratory values before and 24 to 72 hours after treatment were excluded.Results: We identified 144 lysis procedures, and 53 were treated with the AngioJet. Average age was 50 (range, 87-20; median, 49). Arterial thrombus was the indication in 68%; venous in the rest. AKI occurred in 15 of 53 (28%). Baseline Cr in AKI and non-AKI patients was similar, whereas Cr after AngioJet was not (P ¼ .01). Only four patients had a baseline Cr >1.4 (two in each group). Average age of the AKI group was 54 (range 36-74, medium 49), 47% were male, and only one had a baseline Cr >1.4 mg/ dL (not significant for all). Average creatinine increase from baseline in AKI group was 0.5 mg/dL (167% rise; P ¼ .003) compared with e0.07mg/dL (NS) in non-AKI patients. When compared with 53 lysis cases that did not use AngioJet, the Cr change in the AngioJet group was higher (P ¼ .03).Conclusions: This preliminary study suggests that AKI may occur in more than one-quarter of patients treated with the AngioJet, independently of traditional risk factors for AKI (diabetes, baseline Cr, and age). This risk may be due to hemolysis and is under-reported in the literature. Prospective studies and long-term consequences should be undertaken to better define this risk.

Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis

“…These data support studies indicating an association between PMT and renal dysfunction. [11][12][13][14] Although PMT was associated with higher incidence of acute renal dysfunction compared with CDT, there was no significant difference in long-term outcomes between these groups. Among the 22 patients who developed renal dysfunction, the average length of time until return to their baseline creatinine values was 5.1 6 5.2 days, with a maximum value of 23 days.…”

“…After Institutional Review Board approval, Current Procedural Terminology code query of Current Procedural Terminology codes 37184-37188 and 37211-37214 revealed 227 patients undergoing CDT or PMT during the specified time frame. Eightytwo were excluded due to existence of preoperative AKI (9), history of end-stage renal disease (ESRD) (14), or lack of perioperative creatinine and glomerular filtration rate (GFR) values (59). The remaining 145 patients were grouped into one of the four following procedural categories: PMT only (n ¼ 15), PMT with tissue plasminogen activator (tPA) pulse-spray (n ¼ 42), PMT with CDT (n ¼ 70), and CDT only (n ¼ 18).…”

“…11 There are several reported cases in the literature, but these studies fail to fully characterize the incidence or severity of perioperative kidney injury in patients undergoing arterial or venous percutaneous thrombectomy. [11][12][13][14] For this reason, we sought to further characterize and compare the incidence, severity, and time to recovery of AKI in patients undergoing CDT or PMT in our institution.…”