Mathews Jerrin C, Pillai Unnikrishnan, Lacasse Alexander
Department of Internal Medicine, St Mary's health center, St Louis, MO, USA.
NDT Plus. 2011 Aug;4(4):241-3. doi: 10.1093/ndtplus/sfr050. Epub 2011 Apr 27.
Percutaneous mechanical thrombectomy (PMT) has been gaining acceptance as a preferred approach for the treatment of acute deep venous thrombosis (DVT). In addition to treating acute DVT and decreasing the risk of pulmonary embolism, it has been reported that direct extraction of the thrombus decreases the risk of post-thrombotic syndrome (PTS), the economic impact of managing which is reported to account for 75% of the total cost of management of DVT patients. PMT combines localized thrombolysis with mechanical thrombectomy. Recently, there have been some reports of reversible acute kidney injury (AKI) occurring post-PMT. The pathophysiology of AKI in such cases is due to hemoglobinuria-associated acute tubular necrosis. Therefore, the overall prognosis of AKI post-PMT has been reported to be good. We report here a case of AKI post-PMT for an extensive DVT of the lower extremity whereby the patient continues to require HD even 5 months after the procedure. The patient had normal renal function prior to the procedure and evidence of hemoglobinuria at the time of diagnosis of AKI. Our case illustrates that patients with a large thrombus load may develop severe AKI post-PMT thus requiring hemodialysis for an extended period of time. Limiting the length of time that the mechanical thrombectomy is performed and quantifying the amount of effluent obtained would appear to be a prudent practice to reduce the risks of renal failure. However, no specific guidelines exist as for the limits of hemolysed exudates to be collected.
经皮机械血栓切除术（PMT）已逐渐被认可为治疗急性深静脉血栓形成（DVT）的首选方法。除了治疗急性DVT和降低肺栓塞风险外，据报道，直接清除血栓可降低血栓后综合征（PTS）的风险，据报道，PTS的经济影响占DVT患者管理总成本的75%。PMT将局部溶栓与机械血栓切除术相结合。最近，有一些关于PMT后发生可逆性急性肾损伤（AKI）的报道。此类病例中AKI的病理生理学是由于血红蛋白尿相关的急性肾小管坏死。因此，据报道PMT后AKI的总体预后良好。我们在此报告一例因下肢广泛DVT行PMT后发生AKI的病例，该患者在手术后5个月仍需要进行血液透析。患者在手术前肾功能正常，在诊断AKI时出现血红蛋白尿证据。我们的病例表明，血栓负荷大的患者在PMT后可能发生严重AKI，因此需要长时间进行血液透析。限制机械血栓切除术的执行时间并量化获得的流出物量似乎是降低肾衰竭风险的谨慎做法。然而，对于要收集的溶血渗出物的限度尚无具体指南。
