Maher James, Rivero Abel, Zaim Sina, Pappas Peter J, Labropoulos Nicos, Klapholz Marc, Saric Muhamed
Department of Medicine, New Jersey Medical School, University of Medicine and Dentistry, 185 South Orange Avenue, Newark, NJ 07103, USA.
J Clin Ultrasound. 2008 Jun;36(5):321-4. doi: 10.1002/jcu.20405.
Asymptomatic subclavian vein occlusion following insertion of a permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) is not uncommon. We report a case of a dual-chamber PPM in a patient with an unrecognized left subclavian vein occlusion who developed massive left arm edema following ipsilateral implantation of an arteriovenous (AV) hemodialysis graft. We recommend that patients with pre-existing PPM or ICD leads who are in need of vascular access for hemodialysis should have the AV shunts placed in the contralateral arm. If this is unavoidable, then preoperative subclavian vein screening for patency should be mandatory, even in asymptomatic patients. Sonography is an appropriate initial test in such a situation.
永久性起搏器（PPM）或植入式心脏复律除颤器（ICD）植入后出现无症状性锁骨下静脉闭塞并不罕见。我们报告一例双腔PPM患者，该患者存在未被识别的左锁骨下静脉闭塞，在同侧植入动静脉（AV）血液透析移植物后出现严重的左臂水肿。我们建议，已有PPM或ICD导线且需要进行血液透析血管通路的患者，应将AV分流置于对侧手臂。如果无法避免，则术前必须对锁骨下静脉进行通畅性筛查，即使是无症状患者也不例外。在这种情况下，超声检查是合适的初始检查方法。
