Catastrophic paradoxical embolus after hemodialysis access thrombectomy in a patient with a patent foramen ovale.

We present the first case of documented clot in-transit through a patent foramen ovale (PFO), caused by mechanical thrombectomy of a clotted AV fistula. Embolus after access thrombectomy is a rare, but known complication of the procedure. Paradoxical embolus is likewise a rare consequence of a right-sided clot, embolising to the left-sided circulation in a patient with a PFO. Suspected embolus through a PFO after dialysis access thrombectomy has been reported, but no case has ever documented the clot in-transit through the PFO.