DEMOGRAPHICS: In this report, we describe the endovascular management of two patients who developed late post-transplant renal vein thrombosis as a result of thrombosis of inferior vena cava (IVC) filters.
HISTORY: Patient 1 had undergone renal transplant 19 years prior. A few months before transplant, he had an IVC filter placed for a DVT and inability to tolerate anticoagulation due to hemorrhagic renal cysts. He then presented with decreased urine output and abdominal pain of a few days duration. Creatinine was three times his baseline. Duplex ultrasound demonstrated thrombosis of the IVC filter extending down to the transplanted renal vein. Catheter directed thrombolysis was unsuccessful. Patient 2 had undergone IVC filter placement and renal transplant 10 years prior to presentation. He presented to the emergency department with lethargy and right leg swelling for three days. Creatinine was four times his baseline. Duplex ultrasound demonstrated IVC filter thrombosis extending to the bilateral common and external iliac veins. PLAN: Patient 1 underwent percutaneous suction thrombectomy of the renal vein with Penumbra followed by AngioVac thrombectomy of the IVC. He had full renal recovery, and his transplant remains functional 4 years later.
Patient 2 underwent percutaneous suction thrombectomy was performed of the IVC and renal vein followed by catheter directed thrombolysis for residual thrombus. Subsequent venogram demonstrated minimal residual thrombus in the external iliac veins bilaterally, but no thrombus in the common iliac veins as well as patency of the IVC filter. The catheters were removed. He had full renal recovery, and his transplant remains functional 5 years later.
DISCUSSION: Late post-transplant renal vein thrombosis is an uncommon event, but can be successfully managed by percutaneous suction thrombectomy.