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.