•Sowa, Dexter

Title:

Body:

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 filters.

Patient 1 had undergone renal transplant 19 years prior. He had an IVC filter placed due a DVT and inability to tolerate anticoagulation due to hemorrhagic renal cysts. He initially presented with decreased urine output and abdominal pain for a few days. Creatinine was three times his baseline. Duplex demonstrated thrombosis of the IVC filter extending to the transplanted renal vein. Lysis was unsuccessful, and so he underwent suction thrombectomy of the renal vein with Penumbra followed by AngioVac thrombectomy of the IVC. He had renal recovery, and his graft remains functional 4 years later.

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 demonstrated IVC filter thrombosis extending to bilateral iliac veins. Penumbra thrombectomy was performed of the IVC and renal vein followed by lysis. Subsequent venogram demonstrated improvement, and the catheters were removed. He had renal recovery, and his graft remains functional 5 years later.

Late post-transplant renal vein thrombosis is an uncommon event, but can be successfully managed endovascularly, especially in the setting of IVC filter thrombosis.

Relevant history:

Decreasing urine output, lower extremity swelling

Relevant test results:

Elevated creatinine; venous duplex demonstrating thrombosis of IVC extending to transplanted renal vein

Teaching points:

Renal transplants with late renal vein thrombosis can be salvaged with prompt diagnosis and treatment. Suction thrombectomy should be considered for patients presenting with late renal vein thrombosis.