Pulmonary Embolism Following Thrombolysis of Dialysis Access: Is Anticoagulation Really Necessary?

Authors

  • Kellie Calderon,

    1. Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore Long Island Jewish Health Systems (NS-LIJ HS) and Hofstra School of Medicine, Great Neck, New York
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  • Kenar D. Jhaveri,

    1. Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore Long Island Jewish Health Systems (NS-LIJ HS) and Hofstra School of Medicine, Great Neck, New York
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  • Robert Mossey

    1. The Raggio Institute, Great Neck, New York
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Address correspondence to: Kellie Calderon, Division of Kidney Diseases and Hypertension North Shore/LIJ Health System, 100 Community Drive, Great Neck NY 11021, or e-mail: kcalderon@nshs.edu.

Abstract

Vascular access thrombosis frequently complicates maintenance hemodialysis (HD) therapy. It is costly and time consuming to patients and practitioners. Alternatives to surgical thrombectomy have been developed using percutaneous thrombolysis (PT) with pharmacologic lysis, mechanical destruction of thrombus, or a combination of the two. These techniques have been used to successfully restore blood flow through thrombosed HD arteriovenous grafts (AVG), but there is a risk of dislodging thrombi into the venous circulation resulting in pulmonary embolism (PE); it is usually clinically insignificant. We examined our practice and reviewed three cases of dialysis access thrombosis treated with PT complicated by symptomatic PE. Two important questions arose: what is the risk of symptomatic PE after PT, and do patients benefit from systemic anticoagulation?

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