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Pulmonary embolism following thrombolysis of dialysis access: is anticoagulation really necessary?

Kellie Calderon1, Kenar D Jhaveri, Robert Mossey

  • 1Division 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 11021, USA. kcalderon@nshs.edu

Seminars in Dialysis
|November 3, 2010
PubMed

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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