Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis

Objective: The objective of this study was to investigate the risk of postoperative acute kidney injury (AKI) in patients with acute iliofemoral deep venous thrombosis (IFDVT) who underwent percutaneous pharmacomechanical thrombectomy (PMT) using AngioJet (Boston Scientific, Marlborough, Mass) or catheter-directed thrombolysis. Methods: Electronic medical records of patients with acute IFDVT from January 2014 to September 2017 were reviewed. Those who received PMT with AngioJet (AJ-PMT group) or catheter-directed thrombolysis (CDT group) were included in this study. Baseline characteristics were recorded and compared. Postoperative serum creatinine concentration was compared with baseline serum creatinine concentration to determine the occurrence of postoperative AKI. Hemolysis was diagnosed on the basis of the decrease of hematocrit (HCT) and the occurrence of hematuria. The incidence of postoperative AKI in the two groups was analyzed. Univariable analysis and logistic regression analysis were used to determine risk factors that contribute to postoperative AKI. Results: A total 198 patients with acute I FDVT were included (79 in the AJ-PMT group, 119 in the CDT group). Baseline data of the two groups were of no statistical difference. The AJ-PMT group suffered more from acute hemolysis (P = .018). Compared with baseline HCT, the absolute HCT reduction of each group was of statistical significance (P < .01). The percentage change of absolute HCT of the two groups was of statistical significance (P < .01). Univariate analysis and multivariate analysis demonstrated that percutaneous AJ-PMT (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.16-6.82; P = .02), history of major surgery within 3 months of endovascular intervention (OR, 8.51; 95% CI, 2.90-24.94; P < .01), and HCT drop >14% (OR, 2.73; 95% CI, 1.08-6.87; P = .03) are independent risk factors that raise the odds of postoperative AKI. Conclusions: In patients with acute IFDVT, AJ-PMT will raise the risk of postoperative AKI compared with CDT, especially in patients with a history of major surgery within 3 months of endovascular intervention. AJ-PMT causes more hemolysis and hematuria. An HCT drop >14% may indicate upcoming AKI.