Faculty of Medicine, Imperial College London, London, UK.
West London Renal and Transplant Center, Hammersmith Hospital, London, UK.
J Endovasc Ther. 2024 Feb;31(1):136-139. doi: 10.1177/15266028221107878. Epub 2022 Jun 29.
To report a rare case of acute renal vein thrombosis (RVT) that was treated with endovascular thrombectomy and lysis, and discuss potential etiology and indications for catheter-directed management.
A 21-year-old female athlete presented with sudden pain in her left flank and vomiting. A 3-phase computed tomography (CT) angiogram identified total occlusion of the left renal vein with no excretion from the swollen tender left kidney. Catheter-directed thrombolysis and thrombectomy were initiated 24 hours after onset of symptoms. Complete resolution of the RVT with normalized renal function was achieved. Post-operative Doppler ultrasound scan confirmed normal renal resistance and flow in the renal vein. The patient was discharged on Apixaban and remains well at 6 months. Combined hormonal contraception via an intra-vaginal ring and raised Factor VIII activity were the only identified risk factors.
Acute complete RVT with impaired kidney function is rare. Combined hormonal contraception and increased Factor VIII activity were potential risk factors. Endovascular thrombectomy and lysis restored renal perfusion and function, and can be used effectively in the management of fit patients with acutely compromised kidney function from total renal vein obstruction.
报告一例罕见的急性肾静脉血栓形成（RVT）病例，该病例采用血管内血栓切除术和溶栓治疗，并讨论潜在的病因和导管定向治疗的适应证。
一名 21 岁女运动员因左肋部突发疼痛和呕吐就诊。3 期 CT 血管造影显示左肾静脉完全闭塞，肿胀的左肾无排泄功能。症状出现后 24 小时开始进行导管定向溶栓和血栓切除术。RVT 完全缓解，肾功能正常。术后多普勒超声扫描证实肾静脉的肾阻力和血流正常。患者出院时服用阿哌沙班，6 个月后仍状况良好。经阴道环的联合激素避孕和因子 VIII 活性升高是唯一确定的危险因素。
急性完全性 RVT 伴肾功能受损罕见。联合激素避孕和因子 VIII 活性升高可能是潜在的危险因素。血管内血栓切除术和溶栓术恢复了肾灌注和功能，对于因完全性肾静脉阻塞导致急性肾功能受损的健康患者，可有效用于该疾病的治疗。
