Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

Abstract

Number of patients with End Stage Renal Disease (ESRD) is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft) plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

Transcatheter Thrombolysis with Percutaneous Transluminal Angioplasty Using a Trans-Brachial Approach to Treat Thrombosed Arteriovenous Fistulas

“…None of our 30 patients had any signs of symptomatic pulmonary embolism, which could have resulted from a small thrombus load in the AVFs. Our experience was consistent with a previous study indicating a low frequency of embolization of small thrombus fragments into the pulmonary circulation, thus explaining why most patients showed no symptoms of pulmonary embolism [30]. Also, since there were no uniform guidelines regarding long-term anticoagulation or antiplatelet therapy during the perioperative period [31], we did not put all patients on anticoagulation or antiplatelet therapy.…”

Pharmacomechanical Thrombolysis for the Treatment of Thrombosed Native Arteriovenous Fistula: A Single-Center Experience

“…Clinically significant pulmonary embolism is a rare complication of the pharmacomechanical thrombolytic procedure of which the incidence ranges from 0% to 1% [ 21 ]. Shah et al [ 22 ] reported a case of cardiac arrest from bilateral pulmonary emboli following thrombolysis of an arteriovenous fistula. However, usually pulmonary emboli after thrombolysis are clinically asymptomatic and these asymptomatic clots can be dissolved by internal autolysis.…”

Arteriovenous Access Failure, Stenosis, and Thrombosis

“…There are 2 types of thrombosis that can occur: soft, friable clot that disintegrates and a firm fibrin plug. 58 …”