This report presents the endovascular strategies adopted to treat a kidney calculus venous embolism after percutaneous nephrolithotomy and the versatility of endovascular techniques to manage even the most unexpected renovascular complications after urological intervention. According to the literature available in PubMed, Cochrane, SciELO, and Science.gov repositories, this is the first case to our knowledge of renal vein calculus embolism as a complication of percutaneous treatment of kidney stones.
A 62-year-old woman underwent percutaneous nephrolithotomy to treat a left kidney 2.8-cm staghorn calculi. The stone cracked, leaving a residual fragment in the ureteropelvic junction. Abdominal computed tomography revealed a 0.9-mm extrarenal calculus located inside the left retroaortic renal vein. Calculus was captured using a basket catheter system through a 6F 45-cm sheath positioned in the left common femoral vein (CFV) and accessed by dissection to safely conclude the calculus extraction by venous cut down. The patient was asymptomatically discharged 48 hours after the endovascular procedure, under a rivaroxaban anticoagulation regimen, with no symptoms or renal function impairment until the 6 months of follow-up.
The endovascular strategy proposed in this case was effective for calculus rescue and venous flow restoration.
This case reinforces the adaptability of endovascular therapy in an unexpected scenario. A potentially life-threatening extremely rare adverse event following a common urological procedure could be treated with minimally invasive hybrid treatment, preserving renal function and maintaining venous vascular patency. This report may add a discussion of procedures to manage similar events and bring to the literature a possible strategy to solve the problem.
Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2024 Jul 31 [Epub ahead of print]
Cristina Ribeiro Riguetti-Pinto, Carlos Eduardo Virgini-Magalhães, Lívia Ramos Carvalho Marchon, Fernando Augusto Peixoto de Araujo, Henrique Alves Machado, Eduardo de Oliveira Rodrigues Neto, Cristiane Ferreira de Araújo-Gomes, Felipe Borges Fagundes
Teaching and Health Care Unit of Vascular and Endovascular Surgery (CT Vascular), Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil., Department of Urology, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.