Pulmonary embolism following hemodialysis access thrombolysis/thrombectomy.
OBJECTIVE
The increased use of thrombectomy with deliberate pulmonary embolization of thrombus following initial thrombolysis for occluded hemodialysis fistulas prompted the authors to measure the prevalence of pulmonary embolism (PE) due to the procedure.


METHODS
Thirty-one patients with 43 acutely thrombosed polytetrafluoroethylene hemodialysis fistulas were treated with thrombolysis/thrombectomy. Perfusion lung scans were obtained in 22 patients. Patients were also continuously monitored for clinical signs or symptoms of PE.


RESULTS
Perfusion scans were interpreted as consistent with PE in 59% of those studied, but no clinical signs or symptoms were present in 41 of the 43 cases (95%). However, two patients developed both signs and symptoms of acute PE in the postprocedural period and died. One had underlying pulmonary disease and had undergone thrombectomy before. The other had chronic heart disease.


CONCLUSIONS
Thrombolysis/thrombectomy is usually safe and effective, even though many patients develop subclinical PE. The authors urge extreme caution in patients who have underlying pulmonary or cardiac disease and/or have undergone the procedure before.
Department of Radiology, University of Arizona Health Sciences Center, Tucson 85724, USA.
T L
TL
Swan
S H
SH
Smyth
S J
SJ
Ruffenach
S S
SS
Berman
G D
GD
Pond
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011655:Pulmonary Embolism / Q000209:etiology* / Q000517:prevention & control; D006435:Renal Dialysis; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000628:therapy*
D011138:Polytetrafluoroethylene