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Kidney Week

Abstract: PO1051

Acute Atypical Chest Pain from Hemodialysis Access as a Culprit

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Ortiz, Alfonso, University of Miami School of Medicine, Miami, Florida, United States
  • Tabbara, Marwan, University of Miami School of Medicine, Miami, Florida, United States
  • Martinez, Laisel, University of Miami School of Medicine, Miami, Florida, United States
  • Vazquez-Padron, Roberto I., University of Miami School of Medicine, Miami, Florida, United States
  • Duque, Juan Camilo, University of Miami School of Medicine, Miami, Florida, United States
Introduction

Cardiovascular mortality is a well-known fact in CKD and ESKD patients specially in patients who are experiencing a cardiovascular event. There is an increased rate of cardiovascular complications and death. Frequent causes of acute chest pain in patients with ESKD include myocardial infarction, pericarditis, air embolism, acid reflux and complications from catheters but is rare to have complications from functional AVF.

Case Description

40-year-old male with history of ESKD and was on hemodialysis via left brachial- brachial arteriovenous fistula with graft extension, DDKT in 02/2020, HTN and HIV who presented to the ED 1 year after transplant with a week history of worsening sharp, non-radiating chest pain localized at the left hemithorax. Patient referred nausea and vomiting for 2 days. Emesis was as thick mucus possibly blood-streaked; however, no coffee-grounds. Stated he had never experienced this chest pain before. He reported not taking any medication at home for pain. On examination there was no cardiac murmurs, no lung abnormalities on auscultation and he had a patent arteriovenous fistula with good thrill and bruit and no signs of stenosis. Had 2 negative troponin levels with serial EKGs without ischemic changes. An echocardiogram that was negative for wall motion abnormalities or any changes in ejection fraction, ruling out an acute coronary syndrome. He had CXR showing curvilinear density projecting over the left lung base with a CT chest that reported a small curvilinear metallic density at the right ventricular apex. He was not on hemodialysis but before his transplant, he had multiple endovascular procedures including a stent placement to keep a patent AV access. A left upper extremity xray showed a left AV access stent fracture; findings were consistent with an embolized fragment from AVG stent.

He underwent explant of the stent from AVG, but embolized fragment was not removed by CT surgery. Currently patient is chest pain free and asymptomatic.

Discussion

Stent fractures are commonly seen when they are in arteries, however this is an uncommon event in venous system specially in hemodialysis vascular access. Some of the complication associated with stent fracture are related to in-stent stenosis and central vein stenosis, but this is the first report of chest pain from stent fracture migrated to the left ventricle.