Thrombosis Turnaround: Successful Endovascular Rescue in Common Iliac Vein Thrombosis of Kidney Allograft

Introduction: This is a case of kidney transplant dysfunction due to right common iliac vein (civ) thrombosis that occurred 4 years after kidney transplantation. Late venous thrombotic events in kidney transplant patients are rare compared to early arterial or venous thrombosis or stenosis (1). Case Description: A 78-year-old male with history of ESKD status post brain death donor kidney transplant on 3/6/2020 came with abdominal pain. He had an acute kidney injury (AKI) with serum creatinine (SCr) 3.66 mg/dL that had increased from his baseline of 0.77 mg/dL. He was hypotensive. Clinical exam was benign. The doppler ultrasound revealed diminished flow within the renal and iliac veins along with heterogenous echogenic material within iliac vein concerning for occlusion. Nephrostomy tube was deferred due to concern of civ thrombosis and started on a heparin drip. Renal angiogram confirmed right civ and external iliac vein thrombosis extended into both the donor renal vein and inferior venacava. He underwent AngioJet Tissue plasminogen activator and right civ thrombectomy. Urine output (UO) improved immediately post op. SCr started decreasing the next day. The patient was discharged 5 days post op. Discussion: Kidney transplantation is the goal for ESKD patients. Transplanted patients have a better quality of life and improved long term survival. Vascular thrombosis is a rare complication that can result in loss of the allograft. Patients present with AKI and abrupt decrease in UO. There is limited evidence that prophylactic low dose aspirin is beneficial in decreasing the incidence of vascular thrombosis (2). Individuals with high-risk of thrombosis may benefit from anticoagulation (AC) after kidney transplantation (2). Endovascular intervention is the best approach if AC fails (3).