Endovascular Management of Right Renal Vein Thrombosis Involving Inferior Vena Cava Using an Intelligent Aspiration System.

Introduction: Renal vein thrombosis (RVT) is a rare but potentially serious condition, particularly when extending into the inferior vena cava (IVC). It can arise from nephrotic syndrome, hypercoagulable states, or infection, and may compromise renal function or lead to embolic complications. While anticoagulation remains the cornerstone of therapy, endovascular mechanical thrombectomy is emerging as a viable option in selected cases. This case report describes a right RVT with IVC involvement that was successfully treated with a new generation aspiration device. Report: A 60 year old man with recent pyelonephritis presented with nephrotic range proteinuria, microhaematuria, and normal renal function. Computed tomography imaging revealed a 4 cm thrombus in the right renal vein extending into the IVC. Following anticoagulation with low molecular weight heparin and exclusion of thrombophilia or malignancy, the patient underwent urgent endovascular thrombectomy using the Penumbra Lightning 12 system. Dual venous access via the right internal jugular and femoral veins allowed aspiration under intravascular ultrasound guidance. Two aspiration passes achieved complete thrombus removal, which was confirmed by phlebography and follow up duplex ultrasound. No malignancy was found on histology. The patient was discharged with preserved renal function and showed complete thrombus resolution at one month imaging follow up. Discussion: This case demonstrates the feasibility and effectiveness of mechanical thrombectomy for RVT with IVC extension using the Penumbra Lightning 12 system. Originally developed for pulmonary embolism, this large lumen aspiration catheter enables efficient thrombus removal with minimal blood loss. In this patient, the procedure led to rapid vessel clearance, avoidance of thrombolytics, and excellent short term outcomes. The case highlights the expanding role of advanced endovascular techniques in managing complex venous thromboses and supports a multidisciplinary approach. Further studies are needed to define the optimal indications and outcomes for such interventions in renal vein thrombosis.