Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy

Santos, Jolina; Hamadeh, Zaher; Ansari, Naheed

doi:10.1155/2012/183730

Cited by 7 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, data from a period when antibacterial catheter locks were less widely used found about one in 10 strokes in dialysis patients were related to endocarditis . Secondly, a stroke at the time of a vascular access procedure should prompt investigation for a persistent patent foramen ovale . Lastly, vascular access may also affect cerebral hemodynamics: a Japanese hospital stroke registry examined 1168 new strokes including 151 among maintenance hemodialysis .…”

Section: Effects Of Renal‐specific Therapies On Stroke Riskmentioning

confidence: 99%

Evidence for the Prevention and Treatment of Stroke in Dialysis Patients

Herrington

Haynes

Staplin

et al. 2014

Seminars in Dialysis

View full text Add to dashboard Cite

The risks of both ischemic and hemorrhagic stroke are particularly high in dialysis patients of any age and outcomes are poor. It is therefore important to identify strategies that safely minimize stroke risk in this population. Observational studies have been unable to clarify the relative importance of traditional stroke risk factors such as blood pressure and cholesterol in those on dialysis, and are affected by biases that usually make them an inappropriate source of data on which to base therapeutic decisions. Well-conducted randomized trials are not susceptible to such biases and can reliably investigate the causal nature of the association between a potential risk factor and the outcome of interest. However, dialysis patients have been under-represented in the cardiovascular trials which have proven net benefit of commonly used preventative treatments (e.g., antihypertensive treatments, low-dose aspirin, carotid revascularization, and thromboprophylaxis for atrial fibrillation), and there remains uncertainty about safety and efficacy of many of these treatments in this high-risk population. Moreover, the efficacy of renal-specific therapies that might reduce cardiovascular risk, such as modulators of mineral and bone disorder, online hemodiafiltration, and daily (nocturnal) hemodialysis, have not been tested in adequately powered trials. Recent trials have also demonstrated how widespread current practices could be causing stroke. Therefore, it is important that reliable information on the prevention and treatment of stroke (and other cardiovascular disease) in dialysis patients is generated by performing large-scale randomized trials of many current and future treatments.

show abstract

Section: Effects Of Renal‐specific Therapies On Stroke Riskmentioning

confidence: 99%

Evidence for the Prevention and Treatment of Stroke in Dialysis Patients

Herrington

Haynes

Staplin

et al. 2014

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…In the past, CAE with a demonstrable air column in the hemodialysis circuit has been reported [ 6 ]. Use of a hemodialysis catheter outside of hemodialysis and declotting of hemodialysis access have also been reported as causes of CAE [ 7 , 8 ]. With the advent of modern hemodialysis, there are safety measures in hemodialysis machines to protect against CAE, but it may still occur.…”

Section: Discussionmentioning

confidence: 99%

Fatal Cerebral Air Embolism: A Case Series and Literature Review

Mishra

Reddy

Khaja

2016

Case Reports in Critical Care

View full text Add to dashboard Cite

Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.

show abstract

“…Concerns with propagating a PE during thrombectomy (4-9), or extended drug time and infusion volume during catheter-directed thrombolysis should be minimized by the use of USAT in large caliber vein thromboses with a large clot burden. Although our sample size is small, USAT was effective in this population of large diameter access conduits with heavy clot burden.…”

Section: Discussionmentioning

confidence: 99%