Iliofemoral Venous Thrombectomy and Angioplasty in a Patient Following Simultaneous Pancreas-Kidney Transplant: A Case Report.

Simultaneous pancreas-kidney (SPK) transplantation is a recognized treatment for patients with insulin-dependent diabetes and advanced chronic kidney disease or end-stage renal disease (ESRD), offering significant survival benefits. However, it is associated with a higher risk of venous thrombosis, which can jeopardize the survival of the pancreaticoduodenal graft. This case report describes a patient with type 2 diabetes, hypertension, and ESRD who developed acute, occlusive deep vein thrombosis (DVT) involving the right common femoral, profunda femoral, and greater saphenous veins on postoperative day 1 (POD1) following a deceased donor SPK transplant, despite systemic prophylactic anticoagulation. Subsequent imaging of the transplanted pancreas revealed a nonocclusive thrombus in the splenic vein with extension into the portal vein and intermittent reversal of diastolic flow in the pancreatic arterial Y-graft. Persistent leg swelling and a nonresolving DVT prompted interventional radiology consultation on POD15, leading to successful mechanical thrombectomy and balloon angioplasty of the external iliac vein. The improved venous outflow following the thrombectomy procedure subsequently contributed to the resolution of the pancreatic graft thrombosis. This case underscores the complexity of managing post-SPK transplantation complications and highlights the role of interventional radiology in addressing persistent thrombotic events to preserve graft function and patient outcomes.