Fracaso renal agudo tras el uso de trombectomía farmacomecánica en la trombosis venosa aguda

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Abstract

Resumen La trombectomía farmacomecánica (TFM) ha demostrado disminuir la incidencia de síndrome postrombótico tras la trombosis venosa profunda (TVP), reduciendo comorbilidades, costes asociados e ingresos hospitalarios. Presentamos el caso de una mujer de 23 años, sin antecedentes de interés, que debuta con fracaso renal agudo (FRA) tras TFM por TVP en miembro superior. Revisamos la literatura publicada hasta la actualidad referente a FRA tras el uso del sistema de TFM para el tratamiento de TVP. El riesgo de FRA tras TFM es considerable, y aunque el pronóstico sea por lo general benigno, dicha complicación debería ser advertida en la lista de posibles complicaciones asociadas a la TFM. Se ha de insistir en la adecuada hidratación preoperatoria y posoperatoria, limitando los tiempos de trombectomía mecánica y cuantificando el efluente obtenido para reducir el posible daño nefrológico. Enfatizamos la prudencia al indicar TFM en mujeres jóvenes y delgadas.

Translated abstract

Abstract Pharmacomechanical thrombectomy (FMT) has proven to decrease the incidence of post-thrombotic syndrome after deep vein thrombosis (DVT), reducing comorbidities, associated costs and hospital admissions. We present the case of a 23-year-old woman, without medical history of interest, who debuts with acute kidney injury (AKI) after TFM due to upper limb DVT. We review the literature published to date regarding AKI after the use of the FMT system for the treatment of DVT. The risk of AKI after FMT is considerable and although usually benign, this complication should be listed as possible complication after FMT. It is necessary to insist on adequate pre and postoperative hydration by limiting mechanical thrombectomy times and quantifying the effluent obtained to reduce possible nephrological damage. We emphasize prudence when indicating FMT in young and slim females.

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Most cited references 18

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Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

Clive Kearon, Susan R. Kahn, Giancarlo Agnelli … (2008)

This chapter about treatment for venous thromboembolic disease is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggests that individual patient values may lead to different choices (for a full understanding of the grading, see "Grades of Recommendation" chapter). Among the key recommendations in this chapter are the following: for patients with objectively confirmed deep vein thrombosis (DVT) or pulmonary embolism (PE), we recommend anticoagulant therapy with subcutaneous (SC) low-molecular-weight heparin (LMWH), monitored IV, or SC unfractionated heparin (UFH), unmonitored weight-based SC UFH, or SC fondaparinux (all Grade 1A). For patients with a high clinical suspicion of DVT or PE, we recommend treatment with anticoagulants while awaiting the outcome of diagnostic tests (Grade 1C). For patients with confirmed PE, we recommend early evaluation of the risks to benefits of thrombolytic therapy (Grade 1C); for those with hemodynamic compromise, we recommend short-course thrombolytic therapy (Grade 1B); and for those with nonmassive PE, we recommend against the use of thrombolytic therapy (Grade 1B). In acute DVT or PE, we recommend initial treatment with LMWH, UFH or fondaparinux for at least 5 days rather than a shorter period (Grade 1C); and initiation of vitamin K antagonists (VKAs) together with LMWH, UFH, or fondaparinux on the first treatment day, and discontinuation of these heparin preparations when the international normalized ratio (INR) is > or = 2.0 for at least 24 h (Grade 1A). For patients with DVT or PE secondary to a transient (reversible) risk factor, we recommend treatment with a VKA for 3 months over treatment for shorter periods (Grade 1A). For patients with unprovoked DVT or PE, we recommend treatment with a VKA for at least 3 months (Grade 1A), and that all patients are then evaluated for the risks to benefits of indefinite therapy (Grade 1C). We recommend indefinite anticoagulant therapy for patients with a first unprovoked proximal DVT or PE and a low risk of bleeding when this is consistent with the patient's preference (Grade 1A), and for most patients with a second unprovoked DVT (Grade 1A). We recommend that the dose of VKA be adjusted to maintain a target INR of 2.5 (INR range, 2.0 to 3.0) for all treatment durations (Grade 1A). We recommend at least 3 months of treatment with LMWH for patients with VTE and cancer (Grade 1A), followed by treatment with LMWH or VKA as long as the cancer is active (Grade 1C). For prevention of postthrombotic syndrome (PTS) after proximal DVT, we recommend use of an elastic compression stocking (Grade 1A). For DVT of the upper extremity, we recommend similar treatment as for DVT of the leg (Grade 1C). Selected patients with lower-extremity (Grade 2B) and upper-extremity (Grade 2C). DVT may be considered for thrombus removal, generally using catheter-based thrombolytic techniques. For extensive superficial vein thrombosis, we recommend treatment with prophylactic or intermediate doses of LMWH or intermediate doses of UFH for 4 weeks (Grade 1B).

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Diagnosis of thoracic outlet syndrome.

Martin S L Hammond, Tessa Sanders, Uma Rao (2007)

Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred scalene muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90 degrees in external rotation, which usually brings on symptoms within 60 seconds.

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Incidence and cost burden of post-thrombotic syndrome.

John Heit, Aneel A. Ashrani (2009)

Post-thrombotic syndrome (PTS) is a long-term complication of deep-vein thrombosis (DVT), manifesting as swelling, pain, edema, venous ectasia, and skin induration of the affected limb. PTS has been estimated to affect 23-60% of individuals with DVT, frequently occurring within 2 years of the DVT episode. Symptomatic DVT, post-operative asymptomatic DVT, and recurrent DVT are all risk factors for the development of PTS. Treatment of PTS is often ineffective and treatment-related costs represent a healthcare burden. Therefore, prevention of DVT is essential to reduce PTS, and thus improve outcomes and reduce overall healthcare costs. Although recommended by guidelines, appropriate DVT prophylaxis remains considerably underused. This review evaluates the incidence, risk factors, and economic impact of PTS. Increasing the awareness of PTS, and the methods to prevent this complication may help reduce its incidence, improve long-term outcomes in patients, and decrease resulting costs associated with treatment.

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Author and article information

Journal

Journal ID (publisher-id): angiologia

Title: Angiología

Abbreviated Title: Angiología

Publisher: Arán Ediciones S.L. (Madrid, Madrid, Spain )

ISSN (Print): 0003-3170

ISSN (Electronic): 1695-2987

Publication date (Print and electronic): August 2020

Volume: 72

Issue: 4

Pages: 198-203

Affiliations

[1] Madrid orgnameHospital Universitario Ramón y Cajal Spain

Article

Publisher ID: S0003-31702020000400005 Publisher ID: S0003-3170(20)07200400005

DOI: 10.20960/angiologia.00093

SO-VID: a33876db-db5a-411f-9b48-4a7059443e23

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

History

Date accepted : 10 November 2019

Date received : 20 September 2019

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Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 6

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Fracaso renal agudo tras el uso de trombectomía farmacomecánica en la trombosis venosa aguda Translated title: Acute renal failure after the use of pharmacomechanical thrombectomy in acute venous thrombosis

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Abstract

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Most cited references 18

Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

Diagnosis of thoracic outlet syndrome.

Incidence and cost burden of post-thrombotic syndrome.

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