Cardiac arrest following arteriovenous fistula manipulation: a cautionary note

Abstract

Arteriovenous fistulas can lead to a number of different chronic complications. We describe a case where a patient developed a thrombosis within her brachiobasilic arteriovenous fistula, which was manually manipulated in order to restore fistula flow. This resulted in a pulseless electrical activity cardiac arrest within a few minutes. After ten minutes of chest compressions and intubation, there was return of spontaneous circulation. No epinephrine was given nor shocks administered. Patient was extubated within minutes and was alert, orientated and haemodynamically stable. CT pulmonary angiogram showed extensive bilateral pulmonary emboli. Manual manipulation of the arteriovenous fistula lead to significant amounts of thrombus embolising to the pulmonary arteries, and resultant cardiac arrest due to circulatory compromise. Chest compressions likely dislodged these emboli, allowing circulation to recommence. We publish this as a cautionary note of a rare but potentially fatal complication.

Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single‐center experience

“…6 Although these devices have the advantage of being less invasive, the problem of these devices is that they are very expensive (over 100,000 Taiwan dollars), are not Unlike surgical thrombectomy to remove thrombi, MCT and traditional PTA mainly use fragmentation and thrombolysis to manage thrombi. Therefore, the most serious complication, pulmonary embolism, [13][14][15] is a major concern. Thrombus reduction must be optimized before or during MCT.…”

“…Unlike surgical thrombectomy to remove thrombi, MCT and traditional PTA mainly use fragmentation and thrombolysis to manage thrombi. Therefore, the most serious complication, pulmonary embolism, 13–15 is a major concern. Thrombus reduction must be optimized before or during MCT.…”