Introduction

Patients with chronic kidney diseases were long considered to have protection against venous thromboembolism (VTE). Although there are risk factors associated with the renal disease process itself and to dialysis, this protection was traditionally attributed to “uremic coagulopathy”. Recent data however indicates this to be untrue. In end-stage renal disease (ESRD) patients, pulmonary emboli usually arise from thrombus in the large femoral and iliac veins, especially following femoral vein catheterization. With the dramatic increase in the number of patients living with ESRD attributable to better modalities of renal replacement therapy and general care, the number of autogenous arteriovenous fistulas (AVF) is increasing. As a result, they have become not-so-uncommon sources of thrombus and emboli, often harboring a large volume of thrombi. Modalities to salvage thrombosed AVF with percutaneous interventions are used more commonly. The following case demonstrates the risk of pulmonary embolism following attempted salvage of a dysfunctional AVF in a patient with ESRD and co-existing comorbidities.