title: Fatal pulmonary embolism after hemodialysis vascular access declotting.
abstract: METHODS
  Male, 59 FINAL DIAGNOSIS: Pulmonary embolism Symptoms: Cardiac arrest • chest pain • dyspnea
  
  
  METHODS
  - Clinical Procedure: Angioplasty Specialty: Nephrology.
  
  
  OBJECTIVE
  Rare disease.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Nephrology Section, Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, U.S.A.
authors.forename: Seyed-Ali
authors.initials: SA
authors.lastname: Sadjadi
authors.affiliation: Nephrology Section, Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, U.S.A.
authors.forename: Maryam
authors.initials: M
authors.lastname: Sharif-Hassanabadi
keywords: Blood Coagulation; Hypercholesterolemia; Pulmonary Embolism; Renal Dialysis