Massive Intravascular Hemolysis with Mechanical Rheolytic Thrombectomy of a Hemodialysis Arteriovenous Fistula

A 57‐year‐old man with chronic kidney disease stage 5 presented for ambulatory evaluation of his arteriovenous fistula. He underwent rheolytic thrombectomy with tissue plasminogen activator infusion, angioplasty, and brachial artery stenting under local sedation. His immediate postoperative course w...

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Bibliographic Details
Published in:Seminars in dialysis 2013-01, Vol.26 (1), p.E5-E7
Main Authors: Carrera, Louis A., Reddy, Rachita, Pamoukian, Vicken N., Michelis, Michael F., DeVita, Maria V., Rosenstock, Jordan
Format: Article
Language:English
Subjects:
Arteriovenous Shunt, Surgical
Hemolysis
Humans
Kidney Failure, Chronic - therapy
Male
Mechanical Thrombolysis - methods
Middle Aged
Renal Dialysis - adverse effects
Thromboembolism - etiology
Thromboembolism - therapy
Treatment Failure
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Summary:A 57‐year‐old man with chronic kidney disease stage 5 presented for ambulatory evaluation of his arteriovenous fistula. He underwent rheolytic thrombectomy with tissue plasminogen activator infusion, angioplasty, and brachial artery stenting under local sedation. His immediate postoperative course was complicated by hypotension, cardiac dysrhythmias and hyperkalemia requiring emergent hemodialysis, due to severe intravascular hemolysis. This case illustrates that mechanical thrombectomy can cause clinically significant intravascular hemolysis, thus careful postoperative monitoring is recommended.
ISSN:0894-0959
1525-139X
DOI:10.1111/j.1525-139X.2012.01104.x