Abstract Background Despite the controversial evidence, pharmacomechanical thrombectomy (PMT) is increasingly utilized for extensive acute iliofemoral deep vein thrombosis (aIF-DVT). PMT potentially induces acute renal injuries (AKI) through thrombus fragmentation, hemolysis, and subsequent heme aggregation, however, is scarce. Purpose To prospectively assess renal complications following rheolytic PMT for aIF-DVT. Method In this single-center prospective cohort all consecutive adult patients with extensive aIF-DVT (≤21 days) candidates for the rheolytic PMT were included. The key exclusion criteria were mainly a previous history of venous thromboembolism (VTE), an estimated glomerular filtration rate of 60 mL/min/1.73m2, and contraindication for thrombolytics. Patients were followed for 3 months. The present study is part of a cohort with multiple aims, including developing an imaging-based model to predict the success of PMT, necessitating serial imaging. Thus, considering available resources, an arbitrary sample size of 30 patients was chosen. The main outcomes of this report include the incidence of post-PMT AKI (according to KDIGO criteria), oliguria/anuria, gross hematuria, hyperkalemia, and the need for new renal replacement therapy (RRT). Results Renal outcomes have been collected and adjudicated in 23/30 patients (the mean ± standard error of the mean (SEM) of the age was 39.2 ± 3 years and 14 (60.9%) were female) so far (The main baseline characteristics of these patients have been provided in the Table). AKI was confirmed in 6 (26.1%) patients, and 2 (8.3%) patients needed temporary new RRT for 15 and 21 sessions, respectively. Anuria was not detected in any patient, while 3 (13%) patients experienced oliguria within the first 24 hours of the PMT. Post-procedural gross hematuria occurred in 12 (50%) patients and resolved after a median (IQR) of 1 (1-2) days. The mean ± SEM of hemoglobin drop within the first 24 hours after PMT was 1.4 ± 0.2, and in 4 (17.4%) patients this drop was ≥2 g/dL. Except for hematuria, no other overt bleeding was detected. No patient had hyperkalemia, recurrent VTE, permanent need for RRT, or all-cause mortality after the PMT. Renal outcomes in remaining patients along with 3-month residual thrombosis and alteration in Villalta score in the total study population are pending. Conclusion Nearly a quarter of our patients demonstrated AKI after rheolytic PMT, representing a substantial incidence rate. This finding highlights the critical importance of pre-procedural patient selection and close post-procedural monitoring to identify and manage potential renal complications early on.Table of the Baseline characteristics
Jamalkhani et al. (Sat,) studied this question.