Lethal Pulmonary Embolism Following Left Upper Extremity Angiogram/Angioplasty with Thrombectomy at Malfunctioning Arteriovenous Fistula

Abstract

A 41-one-year-old female on chronic hemodialysis with a medical history of systemic lupus erythematosus and end-stage renal disease presented with clotted hemodialysis access. She was sent to the operating room for angiogram/angioplasty with thrombectomy. Although the thrombectomy was successful, toward the end of the case, she went into cardiac arrest secondary to a massive pulmonary embolization that probably originated from her clotted arteriovenous fistula. Spontaneous circulation returned only after a prolonged period of resuscitation using advanced cardiac life support. She was transferred to the medical intensive care unit (ICU) intubated while receiving minimal cardiovascular pharmacological support. Computerized tomography (CT) scan of the head indicated extensive anoxic brain injury and she expired two days later.

A Case Report: Pulmonary Embolism (PE) in Hemodialysis Patients with Autogenous Arteriovenous Fistula (AVF) Occlusion during Ultrasonography

“…However, most of them are transient pulmonary arterial pressure rise, and fatal pulmonary embolism is rare [7]. Most of the reported clinical cases state that symptomatic and even fatal pulmonary embolism appear during the operation of arteriovenous stula or interventional operation under digital subtraction angiography [8,9].However, for this patient, after the internal stula thrombosis, during the ultrasound examination, the thrombus fell off due to the extrusion of the ultrasound probe, which eventually led to fatal pulmonary embolism. Thanks for timely diagnosis, mask oxygen inhalation and ventilator, the patient ultimately had a good prognosis.…”