Saad Theodore F, Hentschel Dirk M, Koplan Bruce, Wasse Haimanot, Asif Arif, Patel Daniel V, Salman Loay, Carrillo Roger, Hoggard Jeff
Department of Medicine, Section of Renal and Hypertensive Diseases, Christiana Care Health System, Newark, Delaware, USA.
Semin Dial. 2013 Jan-Feb;26(1):114-23. doi: 10.1111/j.1525-139X.2012.01103.x. Epub 2012 Aug 15.
Cardiovascular implantable electronic devices (CIEDs) are frequently utilized for management of cardiac dysrhythmias in patients with chronic kidney disease or end-stage renal disease receiving hemodialysis. The survival benefit from use of implantable cardioverter defibrillators in patients with CKD or ESRD is not as clear as in the general population, particularly when used for primary prevention of sudden cardiac death. Transvenous CIED leads are associated with central vein stenosis resulting in significant adverse consequences for existing or future arteriovenous access. Venous hypertension from CIED lead-related central vein stenosis is a challenging clinical problem and may require repeated percutaneous interventions, replacement of the CIED, or creation of alternative arteriovenous access. Infections associated with transvenous CIED leads are more frequent and associated with worse outcomes in patients with renal disease. Epicardial CIED leads or other nontransvenous devices may reduce complications of both central venous stenosis and endovascular infection in these vulnerable patients. Consensus recommendations are offered for avoidance and management of complications arising from the use of CIEDs and arteriovenous hemodialysis access.
心血管植入式电子设备（CIEDs）常用于治疗慢性肾脏病或接受血液透析的终末期肾病患者的心律失常。与普通人群相比，慢性肾脏病或终末期肾病患者使用植入式心脏复律除颤器的生存获益并不明确，尤其是用于心脏性猝死的一级预防时。经静脉CIED导线与中心静脉狭窄相关，会给现有的或未来的动静脉通路带来严重不良后果。CIED导线相关中心静脉狭窄导致的静脉高压是一个具有挑战性的临床问题，可能需要反复进行经皮干预、更换CIED或建立替代动静脉通路。经静脉CIED导线相关感染在肾病患者中更常见，且与更差的预后相关。心外膜CIED导线或其他非经静脉设备可能会减少这些脆弱患者中心静脉狭窄和血管内感染的并发症。本文针对CIEDs及动静脉血液透析通路使用过程中出现的并发症的预防和管理提供了共识性建议。
