ObjectiveTo evaluate the risk factors for hemoglobinuria and acute kidney injury (AKI) after percutaneous mechanical thrombectomy (MT) with or without catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (IFDVT).MethodsPatients with IFDVT who had MT with the AngioJet catheter (group A), MT plus CDT (group B), or CDT alone (group C) from January 2016 to March 2020 were retrospectively evaluated. Hemoglobinuria was monitored throughout the treatment course, and postoperative AKI was assessed by comparing the preoperative (baseline) and postoperative serum creatinine (sCr) levels from the electronic medical records of all patients. AKI was defined as an elevation in the sCr level exceeding 26.5 ​μmol/L within 72 ​h after the operation according to the Kidney Disease Improving Global Outcomes criteria.ResultsA total of 493 consecutive patients with IFDVT were reviewed, of which 382 (mean age, 56 ​± ​11 years; 41% of them were females; 97 in group A, 128 in group B, and 157 in group C) were finally analyzed. Macroscopic hemoglobinuria was evident in 44.89% of the patients of the MT groups (101/225, 39 in group A, and 62 in group B), with no significant difference between the groups (P ​= ​0.219), but not in the patients in group C. None of the patients developed AKI (mean sCr difference −2.76 ​± ​13.80 ​μmol/L, range ​= ​−80.20 to 20.60 ​μmol/L) within 72 ​h after surgery.ConclusionsRheolytic MT is an independent risk factor for hemoglobinuria. A proper aspiration strategy, hydration, and alkalization following thrombectomy are particularly favorable for preventing AKI.