Endovascular Recanalization of Late Venous Thrombosis After Kidney Transplantation by Off-Label Application of Ultrasound Mechanical Thrombolysis (EKOS): A Case Report

Background: Kidney transplantation (KT) represents the best treatment option for patients with end-stage renal disease (ESTD). Graft venous thrombosis is a rare but serious complication. Early diagnosis and prompt treatment are crucial to preserve graft function and survival. Case Presentation: The patient underwent DBD KT for stage V ESRD. The postoperative course was uneventful, without medical or surgical complications. Fifteen days after surgery, the patient presented to the emergency department with anuria. A CT scan demonstrated a complete thrombosis of the renal vein. The thrombosis was managed with an off-label application of the EKOS device. Discussion: There are currently no established guidelines for the management of RVTPT. Surgical intervention, including thrombectomy by renal venotomy, anastomotic repair, or graft explant is the recommended approach in early VT. In contrast, thrombolytic therapy is generally the preferred treatment for thrombosis occurring in the late post-transplant period. The off-label application of ultrasound-mechanical thrombolysis (EKOS) for late renal vein thrombosis after kidney transplantation offers a promising, minimally invasive alternative. Conclusions: This experience highlights the importance of a multidisciplinary approach in the management of surgical and transplant patients.