Local Infusion of Fibrinolytic Agents for Acute Renal Artery Thromboembolism: Report of Ten Cases

doi:10.1007/BF02042655

Annals of Vascular Surgery

Volume 7, Issue 1, January 1993, Pages 21-26

https://doi.org/10.1007/BF02042655 Get rights and content

Management of acute renal artery occlusion remains a therapeutic challenge. We report our experience with 10 cases of acute renal artery occlusion treated primarily by local infusion of fibrinolytic agents. Renal artery occlusion occurred as a result of thrombosis of a stenosed vessel in three cases, from renal artery embolism in two cases, as a complication of percutaneous transluminal angioplasty in four cases, and in association with aortic occlusion in one case. Flank pain was present in all cases and hematuria in four cases. Acute renal failure was seen at the time of presentation in four cases (one case from bilateral occlusion and three cases from an associated nonfunctioning contralateral kidney). Diagnosis was confirmed by renal isotope scanning and arteriography in all cases. All patients were treated by selective infusion of streptokinase or urokinase into the occluded renal arteries. In five cases this was combined with balloon catheter angioplasty. Therapy was initiated within 24 hours from the onset of symptoms in three cases, within 3 days in four cases, within 6 days in two cases, and after 5 weeks. in one case. Successful revascularization was initially achieved in 7 of the 10 cases by arteriographic criteria. Rethrombosis occurred in one patient after 3 days and fibrinolytic therapy was repeated successfully. Renal function was restored in one of the four patients presenting with acute renal failure. One complication necessitating resection occurred as a result of fibrinolytic therapy in the form of acute mesenteric embolism with descending colon infarction. No major bleeding complications were encountered and there were no deaths in this group of patients. Local percutaneous intra-arterial fibrinolytic therapy can recanalize acute renal artery occlusions of variable duration ranging from <24 hours to several weeks and provides a safe and reasonable alternative to surgical intervention in selected cases.

References (13)

CP Fischer et al.
Renal artery embolism: Therapy with intra-arterial streptokinase infusion
J Urol
(1981)
DC Rudy et al.
Segmental renal artery emboli treated with low-dose intra-arterial streptokinase
Urology
(1982)
GF Pineo et al.
Spontaneous renal artery thrombosis: Successful lysis with streptokinase
J Urol
(1987)
JJ Cronan et al.
Low dose thrombolysis: A nonoperative approach to renal artery occlusion
J Urol
(1983)
A Steckel et al.
The use of streptokinase to treat renal artery thromboembolism
Am J Kidney Dis
(1984)
CJ Sanfelippo et al.
Intra-arterial streptokinase and renal artery embolization
Urology
(1978)

There are more references available in the full text version of this article.

Cited by (58)

A case of successful revascularization and renal recovery after 6 days of renal artery occlusion
2024, Journal of Vascular Surgery Cases, Innovations and Techniques
A 72-year-old man with peripheral arterial disease, an atrophic left kidney, and prior right renal chimney stent as part of a complex endovascular abdominal aortic aneurysm repair presented to our emergency department with right flank pain and anuria resulting from right artery occlusion. His serum creatinine on admission was 7.5 mg/dL. Computed tomography angiography 6 days after the onset of his symptoms revealed complete occlusion of the right renal artery stent. Percutaneous thrombectomy was performed restored renal blood flow. The urine flow started the following day, and his serum creatinine decreased to 3.5 mg/dL 7 days after discharge.
Renal Artery Thrombosis After Laparoscopic Living-Donor Nephrectomy: A Case Report
2023, Transplantation Proceedings
Renal transplantation is the most successful treatment for end-stage renal disease, and the number of living-donor nephrectomies has been rising over the years due to the advantages it offers over deceased donors. Although this surgery is considered safe, it can be associated with complications amplified by the fact that it is performed on a healthy individual. Renal artery thrombosis is a rare disease that needs prompt diagnosis and treatment to avoid renal function deterioration, which becomes even more important in cases of solitary kidneys. We report the first case of renal artery thrombosis after laparoscopic living-donor nephrectomy treated with catheter-directed thrombolysis.
Role of late renal revascularization in functional renal salvage
2022, Journal of Vascular Surgery Cases, Innovations and Techniques
The duration that renal parenchyma will tolerate ischemia has continued to be debated. We have reported the cases of three patients who had undergone revascularization procedures with successful return of baseline renal function after prolonged renal artery occlusion of 14 days to 3 months. These cases highlight that aggressive revascularization can lead to successful renal salvage in selected patients. We examined the characteristics of these patients and those of others in the literature and reviewed the factors favoring recovery.
Acute renal artery occlusion in a solitary kidney: An unexpected recovery after late revascularization
2021, Annals of Vascular Surgery - Brief Reports and Innovations
Spontaneous renal artery thrombosis: A rare cause of acute flank pain
2021, Radiology Case Reports
Citation Excerpt :
Given the rarity of this disease, the treatment guideline was not reached on the agreement. As a minimally invasive technique, local percutaneous intra-arterial fibrinolytic therapy can be applied to recanalize acute renal artery occlusions of variable duration ranging from less than 24 hours to several weeks and provide a convenient alternative to surgical intervention in selected cases [9]. Therefore, angiography is still considered as the gold standard to confirm the diagnosis of acute renal artery thrombosis [3,10].
Spontaneous renal artery thrombosis is a rare cause of flank pain and can have fatal consequences. We report a case of acute renal artery thrombosis in a 61-year-old man who experienced flank pain and had no medical history. A contrast-enhanced computed tomography scan revealed total thrombotic occlusion of the left renal artery. The patient was taken to interventional radiology, and an urgent catheter-directed thrombolysis of the renal artery was performed. The procedure was successful, with the subsequent arteriogram demonstrating a substantial decrease of the thrombus extent and the recanalization of the left renal artery. This case highlights that emergency renal artery thrombolysis is an effective and safe treatment for acute occlusion of the renal artery.
Acute renal artery occlusion: Presentation, treatment, and outcome
2016, Journal of Vascular Surgery
Citation Excerpt :
In a series of patients who underwent surgical embolectomies, embolectomy was successful in the relief of hypertension but was ineffective in the restoration of renal function.7 The use of CDT has been described in case reports and short series and currently remains controversial in the management of acute RAO.3,8-10 Although treatment with CDT may successfully re-establish blood flow to the kidney, long-term results are difficult to assess.
Acute renal artery occlusion is an uncommon disease requiring rapid diagnosis for prevention of kidney loss or permanent kidney damage. The purpose of this study was to identify patients with acute kidney infarction; to characterize their presentation, imaging, and treatment; and to compare the subgroup of patients who underwent catheter-directed thrombolysis (CDT) with those who were treated without intervention.
Hospital records between 2005 and 2015 were queried for keywords suggestive of kidney infarction. Patients were divided into two groups: the CDT group and the noninterventional group. Data collected included demographics, comorbidities, methods of diagnosis, and time from presentation to diagnosis. For patients treated with CDT, additional data collected included details of thrombolytic therapy and follow-up studies. The two groups were compared regarding their clinical characteristics and outcome.
Forty-two patients were diagnosed with acute kidney infarction; 13 (31%) were treated with CDT and 29 (69%) were treated conservatively. Median time from presentation to diagnosis was 42 hours in the CDT group and 32 hours in the untreated group. Among the CDT group, complete or partial resolution of the thrombus was seen in all patients. Two required permanent dialysis, both renal transplant patients. Median follow-up was 30 months (interquartile range, 2.7-46.2) in the CDT group and 13 months (interquartile range, 0.11-16) in the noninterventional group. Mean creatinine clearance at diagnosis and at last follow-up was 74.3 and 54.6 mL/min, respectively, in the CDT group (a decrease of 27%; P = .032) and 66.1 and 60 mL/min in the conservatively treated group (a decrease of 9%; P = .04). Follow-up imaging was available in nine patients treated with CDT. Mean interval from treatment to follow-up imaging was 13 months (range, 1-35 months) and consistently showed a functional but smaller treated kidney. (Mean pole-to-pole kidney length at baseline and late follow-up: 10.4 cm and 8.5 cm, respectively).
Most patients presenting with acute kidney infarction are managed conservatively. A subset of patients with complete occlusion of the renal artery undergo CDT with good angiographic results. The treated kidney is expected to decrease in size over time, and overall kidney function is expected to decrease compared with baseline. Deterioration in renal function appears to stabilize and does not continue over time. CDT for acute renal artery occlusion is a safe modality of therapy and should be attempted for the purpose of kidney salvage, even in the setting of prolonged ischemia.

View all citing articles on Scopus

Presented at the Seventeenth Annual Meeting of the Peripheral Vascular Surgery Society, Chicago, Ill., June 7, 1992.

Reprint requests: Alan B. Lumsden, MD, Department of Surgery, M-11, Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA 30322.

View full text

Local Infusion of Fibrinolytic Agents for Acute Renal Artery Thromboembolism: Report of Ten Cases

J Urol

Urology

J Urol

J Urol

Am J Kidney Dis

Urology