Pulmonary Embolism following Successful Thrombectomy of an Arteriovenous Dialysis Fistula

Grebenyuk, L. V.; Marcus, Richard J.; Nahum, Elmer; Spero, Joel A.; Srinivasa, Nanditha; McGill, Rita L.

doi:10.1177/112972980901000111

Cited by 19 publications

(13 citation statements)

References 12 publications

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“…Symptomatic pulmonary emboli can occur with both mechanical and percutaneous thrombolysis procedures. These events can occur with or without preexisting history of cardiovascular disease or thromboembolic events [24, 25]. …”

Section: Pulmonary Emboli During Percutaneous Proceduresmentioning

confidence: 99%

“…Certain cardiopulmonary diseases like atrial fibrillation, congestive heart failure, and intrinsic lung diseases predispose to develop pulmonary embolization [21, 27]. Patients with history of multiple thrombolysis procedures in the past and previous history of thromboembolism are also predisposed to develop pulmonary emboli [24, 25]. This is of significant concern in chronic hemodialysis patients, many of whom have underlying cardiopulmonary disease and undergo frequent thrombectomy procedures.…”

Section: Pulmonary Emboli During Percutaneous Proceduresmentioning

confidence: 99%

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

Shah

Ansari

Hamadeh

2012

Case Reports in Nephrology

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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.

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Section: Pulmonary Emboli During Percutaneous Proceduresmentioning

confidence: 99%

Section: Pulmonary Emboli During Percutaneous Proceduresmentioning

confidence: 99%

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

Shah

Ansari

Hamadeh

2012

Case Reports in Nephrology

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“…One report covered the thrombectomy of a thrombosed arteriovenous fistula and resultant PE, and cautioned that venous emboli may result from fistula manipulation 2. Another two reports cover cases of massive PE resulting from using angioplasty and percutaneous thrombolysis to attempt to declot arteriovenous fistulas 3 4…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest following arteriovenous fistula manipulation: a cautionary note

Gandolfi

Fernando

2017

BMJ Case Reports

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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.

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“…Shah et al reported the case of a 25-year-old African American man in whom access declotting was complicated by bilateral pulmonary emboli and cardiac arrest, but he survived the event [19]. Toosy et al and Grebenyuk et al also reported patients who suffered pulmonary embolism after dialysis access declotting, but in both cases patients survived [20,21]. …”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary embolism after hemodialysis vascular access declotting

Sadjadi

Sharif-Hassanabadi

2014

Am J Case Rep

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Patient: Male, 59Final Diagnosis: Pulmonary embolismSymptoms: Cardiac arrest • chest pain • dyspneaMedication: —Clinical Procedure: AngioplastySpecialty: NephrologyObjective:Rare diseaseBackground:Vascular access is the lifeline of hemodialysis patients and access problems are a major source of morbidity and mortality for these patients. Access stenosis and thrombosis are common problems in dialysis patients and require prompt intervention. Every year thousands of these procedures are performed in the United States by radiologists, surgeons, and interventional nephrologists.Case Report: A 59-year-old man on chronic hemodialysis with multiple medical problems, including diabetes mellitus, hypertension, chronic obstructive lung disease, hepatitis C infection, and end-stage renal disease, who had clotted his access several times before ,presented with another episode of access clotting. He underwent declotting successfully but upon angioplasty of the access feeding artery, he developed massive pulmonary embolism and died. Postmortem examination showed multiple pulmonary emboli, including cholesterol crystals in his lungs.Conclusions:Hemodialysis access declotting and angioplasty are usually benign and do not cause a major problem. However, occasionally they become complicated. In difficult cases and in people with multiple comorbidities, it is preferable to forego the existing dialysis access and either plan for creation of a new vascular access or place a central vein catheter.

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Pulmonary Embolism following Successful Thrombectomy of an Arteriovenous Dialysis Fistula

Cited by 19 publications

References 12 publications

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

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

Cardiac arrest following arteriovenous fistula manipulation: a cautionary note

Fatal pulmonary embolism after hemodialysis vascular access declotting

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