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

Abstract

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

Angio-Jet Thrombolysis for Traumatic Inferior Vena Cava Thrombosis; Case Report and Review of Literature

“…The prognosis of AKI post Angio-Jet is relatively good, with good return of normal renal function in most. However, AKI found to be severe enough requiring temporary dialysis reaching up to 5 months ( 26 , 27 ).…”

Percutaneous rheolytic thrombectomy of thrombosed arteriovenous dialysis access using the AngioJet catheter- A Systematic Review

“…The Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths (PEARL) registry has vaguely mentioned the association between the AngioJet device and the development of acute kidney injury (AKI) [53]. AKI is the result of intravascular haemolysis and haematuria due to high-pressure jet sprays [25, 54, 55]. Recently, it has been a complication increasingly reported by AngioJet thrombectomy patients.…”