Fatal pulmonary embolism after hemodialysis vascular access declotting
Open Access
- 1 January 2014
- journal article
- Published by International Scientific Information, Inc. in The American Journal of Case Reports
- Vol. 15, 172-175
- https://doi.org/10.12659/ajcr.890364
Abstract
Rare disease 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. 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. 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.Keywords
This publication has 21 references indexed in Scilit:
- Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patientsJournal of Thrombosis and Haemostasis, 2012
- Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the LiteratureCase Reports in Nephrology, 2012
- Right atrial thrombi complicating haemodialysis catheters. A meta-analysis of reported cases and a proposal of a management algorithmNephrology Dialysis Transplantation, 2011
- Paradoxical Embolism after Declotting of Hemodialysis Fistulae/Grafts in Patients with Patent Foramen OvaleClinical Journal of the American Society of Nephrology, 2011
- Cardiac Arrest Following Massive Pulmonary Embolism During Mechanical Declotting of Thrombosed Hemodialysis Fistula: Successful Resuscitation With tPAJournal of Intensive Care Medicine, 2008
- Platelet Dysfunction in Renal FailureSeminars in Thrombosis and Hemostasis, 2004
- Declotting, Maintenance, and Avoiding Procedural Complications of Native Arteriovenous FistulaeSeminars in Interventional Radiology, 2004
- Venous thromboembolism in end-stage renal diseaseAmerican Journal of Kidney Diseases, 2000
- [Clinical evaluation of cholesterol embolization syndrome after cardiac catheterization].1998
- Heparin-induced antibodies as a risk factor for thromboembolism and haemorrhage in patients undergoing chronic haemodialysisThe Lancet, 1996