Cardiac implantable electronic device and vascular access: Strategies to overcome problems

Kusztal, Mariusz; Nowak, Krzysztof

doi:10.1177/1129729818762981

Cited by 20 publications

(31 citation statements)

References 41 publications

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“…The mortality rate among dialysis patients depends on the type of vascular access and is higher in patients with catheters and fistulas made of artificial materials [1,4,17,22,[24][25][26][27]. Paradoxically, progress in medicine has led to an increase in infection rate by introducing artificial materials to build new vascular access.…”

Section: Discussionmentioning

confidence: 99%

Infection-related complications in patients with end stage renal failure dialyzed through a permanent catheter

et al. 2020

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Introduction: Progression of renal failure leads to an increase in the number of patients who require forming dialysis access. Old age and rising morbidity make it impossible to form a native arteriovenous fistula and a permanent catheter becomes the first choice. The presence of a catheter frequently generates complications, including infections, which may result in a higher mortality rate. Material and methods: A retrospective analysis data has been conducted, involving 398 patients who had permanent catheters implanted from 2010 to 2016. Out of this group, 65 patients who suffered infectionrelated complications have been identified. Risk factors for infection and a survival rate of the population have been estimated. Results: Between 2010 and 2016, 495 catheters were implanted for 398 patients aged 68.73 (13.26) years on average. 92 catheter-related infections (23.1%) were recorded in 65 patients. Multivariate logistic regression showed, that the risk factors of infectious complications were: younger age (P = 0.000), coronary artery disease (P = 0.006) and heart failure (P = 0.000). Mortality in the mean 1.38 ± 1.17 years followup period was comparable in infectious and non-infectious subgroups (53.85% vs 49.25%; P = 0.588). A higher risk of death in the infectious population was associated with the presence of additional intravascular and intracardiac implanted materials (P = 0.027) and a severe course of infection with hypotension (P = 0.027), thrombocytopenia (P = 0.029) and a high leucocytes/platelets ratio (0.017). Conclusion: Infectious complications in patients dialyzed with permanent catheters are dangerous especially in patients with severe clinical course. The mortality rate is high, although similar to all dialyzed by permanent catheters.

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Section: Discussionmentioning

confidence: 99%

Infection-related complications in patients with end stage renal failure dialyzed through a permanent catheter

et al. 2020

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“…The risk varies between 9–26% of the cases, with either partial or complete occlusion, and it is higher in patients with chronic kidney disease and end stage renal disease who are on hemodialysis [9–11]. Therefore, the need for different approaches in such cases is imminent.…”

Section: Discussionmentioning

confidence: 99%

Unusual Venous Access for Device Implantation

Al‐Sadawi

Budzikowski

2019

Am J Case Rep

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Case seriesPatient: Male, 80 • Female, 67 • Male, 48Final Diagnosis: Management of difficult venous access for implantable cardiac devicesSymptoms: Heart failureMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual clinical courseBackground:Cardiac implantable electronic devices (CIED) are mainstay therapy for a variety of patients with bradyarrhythmia as well as those at risk of sudden cardiac death and heart failure. At present, commonly used venous access are axillary, cephalic cutdown, and subclavian puncture. However, there are situations when these approaches cannot be employed because cannulation is not possible due to small size, spasm, absence, or occlusion of the vein. One of the alternative approaches is through an internal or external jugular vein. A jugular vein approach can be also used for upgrading CIED knowing that CIED is not commonly associated with venous occlusion.Case Report:We present 3 cases which used unusual venous access for placement of CIED using a jugular vein approach.Conclusions:Recognizing patients who have difficult venous access for CIED and using alternative approaches, like a jugular vein approach, for device insertion is important to avoid unnecessary medical and technical complications.

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“…First, transvenous access for CIED should be avoided in patients likely needing HD in the short term, that is, those with rapid CKD progression and/or eGFR < 20 mL/min/1.73 m 2 . If transvenous CIED must be placed, the best strategy in the pre-dialysis patient will be AVF placement on the contralateral arm to CIED and avoidance of CVC if possible [10]. Second, the use of epicardial devices that traverse through the subcutaneous tissue and do not require vascular puncture, as the leads are inserted directly into the epicardium, could be implemented.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…The most common method of CIED insertion is the transvenous placement of the electrical leads, and the left subclavian or cephalic vein approach is preferred by many implanting physicians for CIED lead insertion, due to favorable venous anatomy and optimal shock vectors for ICD therapy. When a vascular access is required, the presence of electrical leads in the central veins could be associated with vascular and infectious complications, which demands an individual approach in access creation [10]. Patients with a pacemaker or an ICD show a similar risk of venous obstruction.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

et al. 2019

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The appropriate vascular access for hemodialysis in patients with cardiac implantable electronic devices (CIED) is undefined. We describe two cases of end-stage renal disease patients with CIED and tunneled central venous catheter (CVC) who developed venous cava stenosis: (1) a 70-year-old man with sinus node disease and pacemaker in 2013, CVC, and a Brescia-Cimino forearm fistula in 2015; (2) a 75-year-old woman with previous ventricular arrhythmia with implanted defibrillator in 2014 and CVC in 2016. In either case, after about 1 year from CVC insertion, patients developed superior vena cava (SVC) syndrome due to stenosis diagnosed by axial computerized tomography. In case 1, the patient was not treated by angioplasty of SVC and removed CVC with partial resolving of symptoms. In case 2, a percutaneous transluminal angioplasty with placement of a new CVC was required. To analyze these reports in the context of available literature, we systematically reviewed studies that have analyzed the presence of central venous stenosis associated with the simultaneous presence of CIED and CVC. Five studies were found; two indicated an increased incidence of central venous stenosis, while three did not find any association. While more studies are definitely needed, we suggest that these patients may benefit from epicardial cardiac devices and the insertion of devices directly into the ventriculus. If the new devices are unavailable or contraindicated, peritoneal dialysis or intensive conservative treatment in older patients may be proposed as alternative options.

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Cardiac implantable electronic device and vascular access: Strategies to overcome problems

Cited by 20 publications

References 41 publications

Infection-related complications in patients with end stage renal failure dialyzed through a permanent catheter

Infection-related complications in patients with end stage renal failure dialyzed through a permanent catheter

Unusual Venous Access for Device Implantation

Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

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