Smits HFM, Blankenstijn PJ, Bom E, Mali WPTM, Van Rijk PP,
Koomans HA
Pulmonary embolism after declotting of thrombosed
catheters
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1420 1996
A clotted hemodialysis arteriovenous (AV) access may be amenable to
mechanical or thrombolytic therapy to re-establish patency. Small clots
invariably will break off and become pulmonary emboli. The consequences of
such emboli are usually not clinically apparent.
The authors studied 22 patients with thrombosed grafts and performed
pulmonary perfusion scans within 24 hours of therapy and, in 5 patients,
about 3 months after the first lung scan. In 8 patients (36%) new
perfusion defects were seen ranging from 1 subsegmental defect (2 patients)
to 4 defects (1 patient). Fourteen patients had perfusion defects seen in
prior studies, some of whom had prior thrombectomy or thrombolysis. Four
of 5 patients showed resolution of the perfusion defects.
Comment: The important observation that pulmonary emboli occur often
during thrombectomy or thrombolytic therapy of clotted AV grafts should be
communicated to the vascular surgeon and interventional radiologist.
Although such pulmonary emboli are often asymptomatic they may contribute
to cardiac and pulmonary dysfunction often seen in hemodialysis patients.
(Harold Bregman, M.D., Lutheran General Hospital, Park Ridge, IL)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: graft/fistula
CRF by organ system :
Lungs