To investigate the management of intravenous misplacement of nephrostomy tube with thrombosis of the inferior vena cava in patient underwent percutaneous nephrolithotomy.

Combined with literature review, the clinical data of 1 case with left kidney cast stone admitted to our hospital in May 2017 was analyzed retrospectively. The male patient aged 59 years. Left side PCNL was performed under general anesthesia. After puncture and establishment of the channel, the field of vision was unclear due to excessive bleeding, we immediately discontinued the surgery, inserted and closed the nephrostomy tube. CT reexamination on the 3rd day after surgery indicated that the nephrostomy tube reached the liver via the left renal vein and inferior vena cava, and thrombosis in the inferior vena cava occurred. Subcutaneous vena cava and left renal artery angiography were performed, and inferior vena cava filter and thrombolytic catheter were inserted, and the nephrostomy tube was extracted under fluoroscopic monitoring.

After the extraction of nephrostomy tube, the patient had no adverse reactions, hemodynamic status was stable, repeated transcatheter angiography showed no extravasation of contrast agent. After thrombolytic therapy, no filling defect was found in inferior vena cava when angiography performed again on the 11th day after surgery, and the filter was recovered successfully.

In percutaneous nephrolithotomy, when nephrostomy tube was intravenous misplaced and with thrombosis of the inferior vena cava, with the help of angiography, the method of gradual and slow extraction of renal tubule and thrombolytic therapy is safe and reliable, which can avoid the secondary injury of surgery and the occurrence of thrombotic related complications.