AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis

Main Article Content

Hultin Sebastian*
Nguyen Tam
Murali Karumathil

Abstract

Background: AngioJetTM rheolytic thrombectomy has been used in the treatment of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome. Though not widely appreciated, it has the potential to cause intravascular haemolysis.


Report: A 37 year old man with no previous medical history presented to his GP with a three week history of progressive right upper limb swelling. Doppler imaging confirmed right upper limb DVT and CT scan demonstrated thoracic outlet syndrome. The patient underwent AngioJetTM thrombectomy followed by IV heparin infusion. Successful revascularisation of the occluded vein was achieved. Overnight he developed haematuria, which was initially attributed to IV heparin. Urinalysis however revealed no red cells or casts. Apart from an Hb drop from 134 to 117 his blood profile and blood film showed no abnormality. He subsequently developed progressive oliguria with marked oedema and acute kidney injury (AKI). His creatinine peaked at 1070umol/l at 96 hours post procedure and he was started on intermittent dialysis. He remained dialysis dependent for 6 days. Ultrasound imaging excluded urinary obstruction. Autoimmune and vasculitic serology were negative. Intravascular haemolysis and haemoglobinuria was confirmed by raised LDH (1714u/L) and low haptoglobin (<0.1units). Direct Coomb’s test, Cold agglutinin test and paroxysmal nocturnal haemoglobinuria screen were negative. The patient’s renal function normalised over 3 months.


Conclusions: The likely cause of this man’s AKI is heme pigment nephropathy from intra-vascular haemolysis. Increased awareness of this condition may allow early identification and intervention to reduce the risk of renal injury from AngioJetTM associated haemolysis.

Article Details

Sebastian, H., Tam, N., & Karumathil, M. (2018). AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis. Journal of Clinical Nephrology, 2(2), 025–028. https://doi.org/10.29328/journal.jcn.1001015
Case Reports

Copyright (c) 2018 Sebastian H. et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The Journal of Clinical Nephrology is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.

License: Copyright © 2017 - 2025 | Creative Commons License Open Access by Journal of Clinical Nephrology is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.

With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.

Compliance 'CC BY' license helps in:

Permission to read and download
Permission to display in a repository
Permission to translate
Commercial uses of manuscript

'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license. 

Tadavarthy SM, Murray PD, Inampudi S, Nazarian GK, Amplatz K.Mechanical thrombectomy with Amplatz device: human experience. J Vasc Interv Radiol. 1997; 5: 715-724. Ref.: https://tinyurl.com/yavvgkpe

Nazarian GK, Qian Z, Coleman CC, Rengel G, Castaneda-Zuniga WR, Hunter DW, et al. Hemolytic effect of the Amplatz thromectomy device. J Vasc Interv Radiol. 1994; 5: 155-160. Ref.: https://tinyurl.com/y7b7gvqh

Dukkipati R, Yang EH, Adler S, Vintch J.Acute kidney injury caused by intravascular haemolysis after mechanical thrombectomy. Nephrology. 2009; 5: 112-116. Ref.: https://tinyurl.com/ybkrltpe

Wagner HJ, Müller-Hülsbeck S, Pitton MB, Weiss W, Wess M. Rapid thrombectomy with hydrodynamic catheter: results from a prospective multicentre trial. Radiol. 1997; 205: 675-681. Ref.: https://tinyurl.com/ybefcvvy

Karthikesalingam A, Young EL, Hinchliffe RJ, Loftus IM, Thompson MM, et al.A systematic review of percutaneous mechanical thrombectomy in the treatment of DVT. Eur J Vasc Endovasc Surg. 2011; 41: 554-565. Ref.: https://tinyurl.com/y6uutp9z

Bunwaree S, Marco Roffi, John M Bonvini, Stéphane Noble, Marc Righini, et al. AngioJet® rheolytic thrombectomy: a new treatment option in cases of massive pulmonary embolism. Interv Cardiol. 2013; 5: 71-87. Ref.: https://tinyurl.com/ydhthtwa

Escobar GA, Dillon B, Matthew RA, Mohammed FF, Ahsan TA, Lewis CL, et al.Risk of Acute Kidney Injury after Percutaneous Pharmacomechanical Thrombectomy Using AngioJet in Venous and Arterial Thrombosis. Ann Vasc Surg. 2017; 42: 238-245. Ref.: https://tinyurl.com/y8mqdmcc

Mair D, T Eastlund, G Rosen, R Covin, JV Harmon, et al.Haemolysis during percutaneous mechanical thrombectomy can mimic a haemolytic transfusion reaction. Transfusion. 2005; 45: 1291-1294. Ref.: https://tinyurl.com/y8txwjtu

Arslan B, Ulku Cenk Turba, Alan H Matsumoto.Acute Renal Failure Associated with Percutaneous Mechanical Thrombectomy for Iliocaval Venous Thrombosis. Semin Intervent Radiol. 2007; 24: 288-295. Ref.: https://tinyurl.com/y9n4zker

Bedi P, Daniel Addanki, Aaron Reichman, Shyan-Yih Chou, Ira Reiser.Acute kidney injury requiring renal replacement therapy due to severe hemolysis after mechanical thrombectomy. Case Rep Int Med. 2016; 3: 87-90. Ref.: https://tinyurl.com/yayrvft2

Whisenant BK, Baim DS, Kuntz RE, Garcia LA, Ramee SR, et al.Rheolytic thrombectomy with the Possis AngioJet: technical considerations and initial clinical experience. J Inva sive Cardiol. 1999; 11: 421-426. Ref.: https://tinyurl.com/y8ze2b8m

Kasirajan K, Gray B, Ouriel K. Percutaneous AngioJet thromectomy in the management of extensive deep venous thrombosis. J Vasc Int Radiol. 2001; 12: 179-185. Ref.: https://tinyurl.com/y7jqqrfr

Plate G, Eklöf B, Norgren L, Ohlin P, Dahlström JA.Venous thrombectomy for iliofemoral vein thrombosis–10 year resilts of a prospective randomised study. Eur J Vasc Endovasc Surg. 1997; 14: 367-374. Ref.: https://tinyurl.com/yd2z36ho

Han X, Baolei Z, Xuemin W, Wenming W, Chao M, et al. Mechanical thrombectomy device AngioJetTM is effective for the treatment of acute deep venous thrombosis. Biomedical Research. 2017; 28: 5084-5088. Ref.: https://tinyurl.com/ya29rvco