Catheter-related deep vein thrombosis complicated by iatrogenic pulmonary embolism after thrombectomy leading to hemodialysis failure and successful rescue by automated peritoneal dialysis : A case report
- 1Department of Nephrology, Chongqing Yubei People’s Hospital, Chongqing, China
- 2Department of Oncology and Hematology, Chongqing Yubei People’s Hospital, Chongqing, China.
Abstract
Rationale:: Catheter-related deep vein thrombosis (DVT) is a serious complication in hemodialysis (HD) patients and may lead to pulmonary embolism (PE). Interventional treatment of catheter-related DVT may be complicated by acute PE and other life-threatening events. When recurrent vascular access failure and cardiovascular intolerance make HD unsustainable, automated peritoneal dialysis (APD) may provide an alternative renal replacement strategy. We report a case of successful rescue with APD after severe complications following interventional treatment of catheter-related DVT.
Patient concerns:: An 82-year-old woman with end-stage renal disease developed right femoral vein thrombosis shortly after initiating urgent-start HD via a femoral catheter. Following percutaneous mechanical thrombectomy and catheter-directed thrombolysis, she developed acute hypoxemia, pulmonary embolism, severe thrombocytopenia, heart failure, and gastrointestinal bleeding. Recurrent central venous catheter dysfunction and repeated hypotension and oxygen desaturation during HD made continued conventional HD increasingly difficult.
Diagnoses:: The patient was diagnosed with catheter-related DVT complicated by acute PE following interventional thrombectomy.
Interventions:: The patient received intensive supportive care, including anticoagulation when clinically feasible, continuous renal replacement therapy, blood transfusions, and management of gastrointestinal bleeding and heart failure. Because of recurrent central venous catheter dysfunction and intolerance to conventional HD, a multidisciplinary team recommended peritoneal dialysis (PD). After clinical stabilization and PD catheter placement, she was transitioned to APD.
Outcomes:: After APD initiation, the patient’s uremic symptoms and lower-extremity edema resolved, and her functional capacity improved from bedridden to independent walking. Hemoglobin increased from 65.7 to 118.2 g/L, cardiac function improved, and adequate dialysis was achieved with a total dialysis adequacy index of 2.58. During approximately 10 months of follow-up, she remained free from peritonitis and PD catheter dysfunction.
Lessons:: This case highlights the risk of serious thromboembolic complications following interventional treatment of catheter-related DVT in HD patients. When recurrent vascular access failure and cardiovascular intolerance render conventional HD unsustainable, timely reassessment of dialysis modality is crucial; APD may offer an effective rescue strategy for selected elderly patients.
Related
- When anatomy challenges access: successful thrombectomy in posterior cerebral artery stroke with PICA-VA variant
- Mechanical thrombectomy for superior sagittal sinus thrombosis in early pregnancy: a case report
- Surgical thrombectomy with preservation of the bioprosthetic aortic valve in obstructive valve thrombosis during complex redo cardiac surgery
- Endovascular mechanical thrombectomy for the treatment of extensive postpartum cerebral venous sinus thrombosis: a case report
- Percutaneous closure of an iatrogenic left atrial-aortic perforation complicated by cardiac tamponade and coronary vasospasm during transseptal puncture: a case report
BibTeX
@article{lu2026catheterrelated,
title = {{Catheter-related deep vein thrombosis complicated by iatrogenic pulmonary embolism after thrombectomy leading to hemodialysis failure and successful rescue by automated peritoneal dialysis : A case report}},
author = {Wenhui Lu and Rui Gong and Xi Liu and Chengyin Yang and Ruixue Li and Hui Yang},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051337},
url = {https://europepmc.org/article/PMC/PMC13727232},
note = {CC BY},
}
RIS
TY - JOUR
TI - Catheter-related deep vein thrombosis complicated by iatrogenic pulmonary embolism after thrombectomy leading to hemodialysis failure and successful rescue by automated peritoneal dialysis : A case report
AU - Wenhui Lu
AU - Rui Gong
AU - Xi Liu
AU - Chengyin Yang
AU - Ruixue Li
AU - Hui Yang
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051337
UR - https://europepmc.org/article/PMC/PMC13727232
AB - Rationale:: Catheter-related deep vein thrombosis (DVT) is a serious complication in hemodialysis (HD) patients and may lead to pulmonary embolism (PE). Interventional treatment of catheter-related DVT may be complicated by acute PE and other life-threatening events. When recurrent vascular access failure and cardiovascular intolerance make HD unsustainable, automated peritoneal dialysis (APD) may provide an alternative renal replacement strategy. We report a case of successful rescue with APD after severe complications following interventional treatment of catheter-related DVT. Patient concerns:: An 82-year-old woman with end-stage renal disease developed right femoral vein thrombosis shortly after initiating urgent-start HD via a femoral catheter. Following percutaneous mechanical thrombectomy and catheter-directed thrombolysis, she developed acute hypoxemia, pulmonary embolism, severe thrombocytopenia, heart failure, and gastrointestinal bleeding. Recurrent central venous catheter dysfunction and repeated hypotension and oxygen desaturation during HD made continued conventional HD increasingly difficult. Diagnoses:: The patient was diagnosed with catheter-related DVT complicated by acute PE following interventional thrombectomy. Interventions:: The patient received intensive supportive care, including anticoagulation when clinically feasible, continuous renal replacement therapy, blood transfusions, and management of gastrointestinal bleeding and heart failure. Because of recurrent central venous catheter dysfunction and intolerance to conventional HD, a multidisciplinary team recommended peritoneal dialysis (PD). After clinical stabilization and PD catheter placement, she was transitioned to APD. Outcomes:: After APD initiation, the patient’s uremic symptoms and lower-extremity edema resolved, and her functional capacity improved from bedridden to independent walking. Hemoglobin increased from 65.7 to 118.2 g/L, cardiac function improved, and adequate dialysis was achieved with a total dialysis adequacy index of 2.58. During approximately 10 months of follow-up, she remained free from peritonitis and PD catheter dysfunction. Lessons:: This case highlights the risk of serious thromboembolic complications following interventional treatment of catheter-related DVT in HD patients. When recurrent vascular access failure and cardiovascular intolerance render conventional HD unsustainable, timely reassessment of dialysis modality is crucial; APD may offer an effective rescue strategy for selected elderly patients.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -