Department of Renal Medicine, Guy's & St Thomas' NHS Foundation Trust,, Great Maze Pond, London, SE1 9RT, United Kingdom.
Vascular Surgery Department, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom.
J Med Case Rep. 2021 Sep 10;15(1):459. doi: 10.1186/s13256-021-03062-3.
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.
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.
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.
AngioJet® 是一种越来越多地用于治疗动静脉血栓形成患者的经皮机械血栓切除术方法。AngioJet® 已被证明会普遍引起血管内溶血。我们报告了一例 29 岁患者，他接受了 AngioJet® 血栓切除术，术后发生 3 级急性肾损伤（AKI），需要肾脏替代治疗（RRT），继发于血管内溶血。我们旨在探讨这些患者发生 AKI 的机制和潜在危险因素，并提出优化患者管理的步骤。
一名 29 岁白人男性，因股静脉支架闭塞行 AngioJet® 血栓切除术，发生 3 级 AKI，需要 RRT。尿液和实验室检查显示存在血管内溶血的证据，这可能是 AKI 的原因。在短暂的 RRT 后，他完全恢复了肾功能。
AKI 是 AngioJet® 血栓切除术后越来越被认识到的并发症，但在临床实践中仍未得到充分重视。AKI 是由该设备引起的血管内溶血引起的。多达 13%的患者需要 RRT，但总体短期预后良好。AKI 发展的术前危险因素包括近期大手术。对于发生肾功能损害的患者，应给予碳酸氢钠。肾活检风险高，且对管理无益。提高临床医生对术后 AKI 的认识和警惕性，可以早期识别并转介到肾病科进行持续管理。
