title: Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis.
abstract: Percutaneous mechanical thrombectomy (PMT) is regularly used in the treatment of both venous and arterial thrombosis. Although there has been no formal report, PMT has been linked to cases of reversible postoperative acute kidney injury (AKI). The purpose of this study is to evaluate the risk of renal dysfunction in patients undergoing PMT vs catheter-directed thrombolysis (CDT) for treatment of an acute thrombus.
  
  
  
  This study is a retrospective review of all patients in a single institution with a Current Procedural Terminology code for PMT or CDT from January 2009 through December 2014. Each patient was grouped into one of the four following procedural categories: PMT only, PMT with tissue plasminogen activator (tPA) pulse-spray, PMT with CDT, or CDT only. Preoperative and postoperative creatinine and glomerular filtration rate (GFR) values were obtained for each patient. The RIFLE (Risk, Injury, Failure, Loss, and End-stage renal disease) criteria were used to categorize the extent of renal dysfunction. χ2analysis, one-way analysis of variance, and unpaired t-test were used to assess significance.
  
  
  
  A total of 227 patients were reviewed, of which 82 were excluded due to either existence of preoperative AKI, history of end-stage renal disease, or lack of clinical data. Of the remaining 145 patients, 53 (37%) presented with arterial thrombosis (mean age, 62 years; 43% male) and 92 (63%) presented with venous thrombosis (mean age, 48 years; 45% male). The incidence of renal dysfunction was highest in the PMT/tPA pulse group (21%), followed by the PMT group (20%) and the PMT/CDT group (14%). CDT was not associated with renal dysfunction. PMT (P = .046), and PMT/tPA pulse (P = .033) were associated with higher rates of renal dysfunction than the CDT controls. The average preoperative GFR for the 22 patients who developed AKI was 53.7 ± 9.4 mL/min/1.73 m2. The minimum postoperative GFR within 48 hours was an average of 35 ± 16 mL/min/1.73 m2. Stratified by the RIFLE criteria, 13 (9%) patients progressed to the risk category, 6 (4%) progressed to the injury category, and 3 (2%) progressed to the failure category. None of the patients who developed renal dysfunction from PMT progressed to dialysis within the same admission period.
  
  
  
  The use of PMT as a treatment for vascular thrombosis is associated with renal dysfunction. Patients treated with PMT require postoperative vigilance and renal protective measures.
authors.affiliation: Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Morrow
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Kim
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Plato
authors.affiliation: Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Shevitz
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Jerry
authors.initials: J
authors.lastname: Goldstone
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Henry
authors.initials: H
authors.lastname: Baele
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio. Electronic address: vikram.kashyap@uhhospitals.org.
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Kashyap
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio; D018579:Patient Selection; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator