AngioJet device amidst stylized veins, symbolizing kidney health.

AngioJet Thrombectomy: Weighing the Risks of Kidney Injury

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A new study sheds light on the increased risk of acute kidney injury (AKI) associated with the AngioJet procedure compared to catheter-directed thrombolysis for deep vein thrombosis."

Deep vein thrombosis (DVT), particularly when it affects the iliofemoral veins in the pelvis and legs, is a serious condition that can lead to long-term complications like post-thrombotic syndrome. This syndrome causes chronic pain, swelling, and skin changes, significantly impacting quality of life. To prevent these complications, prompt and effective treatment is essential.

Two common approaches for treating acute iliofemoral DVT are catheter-directed thrombolysis (CDT) and percutaneous pharmacomechanical thrombectomy (PMT). CDT involves delivering clot-dissolving drugs directly to the thrombus through a catheter. PMT, on the other hand, uses mechanical devices to break up and remove the clot, often in conjunction with medication. One such device is the AngioJet system, which utilizes a high-pressure saline jet to fragment and aspirate the thrombus.

While AngioJet offers the advantage of rapid clot removal, recent research suggests it may come with a higher risk of acute kidney injury (AKI) compared to CDT. This article will explore the findings of a new study investigating this potential risk and discuss the implications for patients with iliofemoral DVT.

AngioJet vs. CDT: Understanding the Kidney Injury Risk

AngioJet device amidst stylized veins, symbolizing kidney health.

A study published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders compared the outcomes of patients undergoing AngioJet PMT and CDT for acute iliofemoral DVT. The researchers reviewed the medical records of 198 patients treated at a single center between January 2014 and September 2017. Of these, 79 patients received AngioJet PMT, while 119 underwent CDT.

The study revealed a significant difference in the incidence of postoperative AKI between the two groups. AKI developed in 22.8% of patients in the AngioJet group compared to only 9.2% in the CDT group. Further analysis identified several independent risk factors for AKI following these procedures:

AngioJet PMT: Patients undergoing AngioJet PMT had a 2.82 times higher odds of developing AKI compared to those receiving CDT.
Recent Major Surgery: A history of major surgery within three months of the endovascular intervention was associated with an 8.51 times increased risk of AKI.
Significant Hematocrit Drop: A decrease in hematocrit (the percentage of red blood cells in the blood) of more than 14% was linked to a 2.73 times higher risk of AKI.

The researchers also found that the AngioJet group experienced a higher incidence of acute hemolysis (destruction of red blood cells), which can lead to hematuria (blood in the urine). This finding suggests that the mechanical action of the AngioJet device may contribute to kidney injury by releasing harmful substances from damaged red blood cells.

Making Informed Decisions About DVT Treatment

The study highlights the importance of carefully weighing the risks and benefits of different treatment options for acute iliofemoral DVT. While AngioJet PMT can be effective for rapid clot removal, the increased risk of AKI, particularly in patients with recent major surgery or those prone to significant hematocrit drops, should be taken into consideration. Patients should discuss these risks with their vascular surgeon to determine the most appropriate treatment strategy for their individual circumstances. Maintaining adequate hydration, using renal protective measures, and closely monitoring kidney function after the procedure are crucial steps to minimize the risk of AKI.

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Everything You Need To Know

What is the main finding regarding the risk of kidney injury when comparing AngioJet PMT to CDT for iliofemoral DVT?

The main finding is that patients undergoing AngioJet pharmacomechanical thrombectomy (PMT) have a significantly higher risk of developing acute kidney injury (AKI) compared to those treated with catheter-directed thrombolysis (CDT). The study showed that 22.8% of patients in the AngioJet group experienced AKI, whereas only 9.2% of patients in the CDT group developed the condition.

What are the potential long-term consequences of iliofemoral deep vein thrombosis (DVT) that prompt the need for treatments like AngioJet or CDT?

Iliofemoral DVT can lead to serious long-term complications, including post-thrombotic syndrome. This syndrome causes chronic pain, swelling, and skin changes in the affected leg, which can significantly impair a patient's quality of life. Prompt and effective treatment, such as AngioJet PMT or CDT, is essential to prevent these debilitating consequences.

Besides AngioJet PMT, what other factors increase the risk of acute kidney injury (AKI) following treatment for iliofemoral DVT?

Apart from AngioJet PMT, the study identified two other independent risk factors for AKI. A history of major surgery within three months of the endovascular intervention was associated with a substantially increased risk. Additionally, a significant drop in hematocrit (a decrease of more than 14%) also elevated the risk of AKI following either AngioJet PMT or CDT.

How does the AngioJet system potentially contribute to acute kidney injury (AKI), as suggested by the study?

The study suggests that the AngioJet system's mechanical action might contribute to AKI. It found that the AngioJet group experienced a higher incidence of acute hemolysis, or the destruction of red blood cells. This process can release substances harmful to the kidneys. Therefore, the mechanical nature of AngioJet, which uses a high-pressure saline jet to fragment and aspirate the thrombus, could lead to kidney injury through the release of these harmful substances from damaged red blood cells.

What considerations should patients and vascular surgeons take into account when choosing between AngioJet PMT and CDT for iliofemoral DVT?

When deciding between AngioJet PMT and CDT, patients and vascular surgeons must carefully weigh the risks and benefits. AngioJet offers rapid clot removal, but the increased risk of AKI, especially in patients with recent major surgery or significant hematocrit drops, must be considered. Patients should discuss these risks, as well as the potential for acute hemolysis, with their vascular surgeon to determine the best treatment strategy. Maintaining adequate hydration, using renal protective measures, and closely monitoring kidney function after the procedure are crucial steps to minimize the risk of AKI, regardless of the chosen method.