Acute Kidney Injury Due to Ureter Compression Following Iliac Venous Stenting.

Purpose: To report the occurrence of acute postrenal kidney failure caused by external ureteral obstruction after iliac venous stent placement.

Case report: A 73-year-old male patient presented with a chronic swelling and feeling of heaviness of his right leg. The presence of venous thrombosis was excluded by duplex ultrasound (DUS). However, DUS revealed a high-grade non-thrombotic stenosis of the right external iliac vein which was confirmed by computed tomography venography. This stenosis was attributed to local scarring following prostatectomy, lymphadenectomy, and adjuvant radiation therapy for prostate cancer 7 years before. According to the clinical presentation, the patient underwent catheter-based revascularization by implantation of a dedicated venous stent in the external iliac vein. One day after this procedure, the patient experienced acute kidney failure, which was attributable to an incipient right-sided grade II hydronephrosis. Subsequent ureterorenoscopy demonstrated a stenotic lesion of the intermediate part of the ureter at the same level as the venous stent. Finally, ureteral stent placement resulted in the restoration of urinary drainage as well as resolution of acute kidney failure. This case report highlights the importance of considering nonvascular complications after venous stent placement and it stresses the importance of postprocedural clinical and laboratory surveillance and follow-up.

Clinical impact: In recent years the number of endovenous stent implantations has significantly increased. In patients with clinically relevant iliofemoral obstructions, endovenous stent placement potentially reduces related symptoms and improves quality of life. However, endovenous stent placement may have an impact on peri-vascular structures, such as the ureters. This case report highlights the awareness of potential nonvascular complications, which might be caused by iliofemoral stent implantation.