Early Discharge Protocol for Patients With Uncomplicated Deep Vein Thrombosis: Cohort Characterization and Incidence of Major Bleeding, Minor Bleeding, and Recurrence

percutaneous aspiration.She was discharged with excellent allograft function and a creatinine (Cr) level of 0.98 after 10 days of hospital stay.Four days later, the patient presented with swollen right lower extremity, decreased urine output, hematuria, and acute renal failure with Cr 1.7.The patient had a high pretest probability for DVT, and an urgent ultrasound revealed right iliofemoral DVT with no flow in the RV, which warranted immediate heparinization.Results: With recent perinephric hematoma as well as a history of bleeding hemorrhoids, the decision was to proceed with single-session pharmaco-mechanical thrombectomy (PMT).Jugular access was selected to avoid manipulation of the acute thrombus in the lower extremity with primary goal of restoring RV outflow.A transjugular inferior vena cava (IVC) filter was placed first.Selective venography with catheter in the EIV using CO2 showed extensive thrombus in the right EIV(Fig 1,A).PMT of the iliac veins only with Angiojet device and 10 mg of tPA was performed.Completion CO2 venogram showed excellent flow in the iliac veins and filling of the allograft (Fig 1 ,B) That was confirmed with intravascular ultrasound as well as angiography using 10 ml of iodinated contrast demonstrating brisk flow in the EIV and RV (Fig 2).After surgery, the patient remained oliguric with rising Cr up to 7.25 and required hemodialysis for 5 days.She was placed on heparin and transitioned to warfarin upon discharge after 2 weeks.She regained kidney transplant function with Cr 1.6 and minimal leg swelling.At 9-month follow-up, Cr 1.8, and she continued on warfarin with complete lower extremity thrombus resolution and underwent IVC filter removal.She expired 4 years after transplantation from unrelated disease with a functioning kidney and Cr 1.39.Conclusions: Endovascular thrombectomy is a safe and effective therapy to treat acute iliofemoral DVT compromising renal transplant function in the relatively early postoperative period.CO2 venography is adequate for guidance and can minimize contrast nephrotoxicity.