Santos Jolina Pamela, Hamadeh Zaher, Ansari Naheed
Renal Division, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, New York, NY 10461, USA.
Case Rep Nephrol. 2012;2012:183730. doi: 10.1155/2012/183730. Epub 2012 Sep 25.
Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT) scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.
血栓切除术是一种常见的手术，用于清除血栓形成的透析动静脉内瘘（AVF）或动静脉移植物（AVG）中的血栓。与血管通路血栓切除术相关的并发症，如肺栓塞，已有报道，但反常栓塞极为罕见。我们报告一例74岁黑人男性病例，其既往病史有终末期肾病（ESRD）、正在使用华法林抗凝治疗的房颤，在对堵塞的AVG进行血栓切除术后，出现嗜睡、失语和右侧偏瘫，前来我院就诊。脑部计算机断层扫描（CT）显示左后顶叶有低密度影。入院时国际标准化比值（INR）为2.0。超声心动图显示左心房大小正常，无心腔内血栓，气泡检查显示存在右向左分流。这些发现提示中风是由AVG来源的栓子所致。反常性脑栓塞并不常见，但可发生在ESRD患者堵塞的血管通路血栓切除术后。临床医生和患者应意识到血管通路手术的这种严重且可能致命的并发症。
