The Impact of Transvenous Cardiac Devices on Vascular Access Patency in Hemodialysis Patients

Abstract

Creating a vascular access in the presence of a cardiovascular implantable electronic device (CIED) in a patient with or approaching end-stage renal disease can be challenging. In this study, we aimed to evaluate the impact of a CIED on the outcomes of vascular access creation in hemodialysis patients and determine their effects on vascular access patency. This is a single-center retrospective review of hemodialysis patients who underwent vascular access creation after CIED placement. Outcomes of vascular access creation and need for endovascular interventions were compared between patients with vascular access created ipsilateral and contralateral to the site of CIED. Comparing patients with arteriovenous (AV) access created ipsilateral to CIED placement (n=19) versus the contralateral side (n=17), the primary failure rate was 78.9% versus 35.3% (p=0.02). For AV accesses that were matured, the median primary patency durations for AV accesses created ipsilateral to the CIED was 11.2 months compared to 7.8 months for AV accesses created contralateral to the CIED (p=1.00). AV accesses created ipsilateral to a CIED have a higher primary failure rate compared with the contralateral arm and should be avoided as much as possible.

Leadless pacemaker placement in a patient with chronic kidney disease: A strategy to preserve central veins

“…In addition to upper extremity fistulas, these patients frequently require large bore nontunneled/tunneled central venous dialysis catheters during their lifetime . The risk of vascular access failure including central venous occlusion can be devastating …”

“…2 The risk of vascular access failure including central venous occlusion can be devastating. 2,3 The incidence of cardiac rhythm disorder in the Chronic Kidney Disease (CKD) population remains high, frequently requiring a cardiac implantable electronic device. 4 A conventional cardiac implantable device with transvenous leads in such patients causes crowding of hardware in the central veins leading to a high incidence of central venous stenosis.…”

Stent use for hemodialysis access: What a general nephrologist needs to know

“…[39][40][41] Stenosis results from the indwelling transvenous leads of IECD placed in the subclavian vein. 42 Treatment of central vein stenosis due to IECD with PTA alone has been evaluated by a multiple center study, which found the primary patency rates of 18% and 9% at 6 and 12 months, respectively 43 with need for more than 2.1 procedures per year to maintain long-term patency. 40 A retrospective review of 36 hemodialysis patients who underwent vascular access creation, the primary access failure for AVF created ipsilateral to an existing IECD was 78.9% versus 35.3% those created on the contralateral side.…”

“…40 A retrospective review of 36 hemodialysis patients who underwent vascular access creation, the primary access failure for AVF created ipsilateral to an existing IECD was 78.9% versus 35.3% those created on the contralateral side. 42 Treatment of central vein stenosis due to IECD with PTA alone has been evaluated by a multiple center study, which found the primary patency rates of 18% and 9% at 6 and 12 months, respectively 43 with need for more than 2.1 procedures per year to maintain long-term patency. The decision process with central vein stenosis in presence of ipsilateral IECD can be complex.…”

Ipsilateral Basilic Vein Transposition in a Patient With a Pacemaker

“…Patients aged greater than 65 years and with comorbidities are also increasing, especially those with diabetes and cardiovascular diseases. For these reasons, it is more common to see patients with cardiovascular implantable electronic devices (CIEDs) (1).…”