Tan Chieh Suai, Jie Cui, Joe Jennifer, Irani Zubin D, Ganguli Suvranu, Kalva Sanjeeva Prasad, Wicky Stephan, Wu Steven
Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United StatesDivision of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United StatesDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United StatesDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
Semin Dial. 2013 Nov-Dec;26(6):728-32. doi: 10.1111/sdi.12073. Epub 2013 Mar 5.
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.
在患有或接近终末期肾病的患者中，在存在心血管植入式电子设备（CIED）的情况下建立血管通路可能具有挑战性。在本研究中，我们旨在评估CIED对血液透析患者血管通路建立结果的影响，并确定其对血管通路通畅性的作用。这是一项对在CIED植入后接受血管通路建立的血液透析患者进行的单中心回顾性研究。比较了在CIED部位同侧和对侧建立血管通路的患者的血管通路建立结果和血管内干预需求。比较CIED植入同侧建立动静脉（AV）通路的患者（n = 19）与对侧建立AV通路的患者（n = 17），原发性失败率分别为78.9%和35.3%（p = 0.02）。对于成熟的AV通路，CIED同侧建立的AV通路的中位原发性通畅持续时间为11.2个月，而CIED对侧建立的AV通路为7.8个月（p = 1.00）。与对侧手臂相比，CIED同侧建立的AV通路原发性失败率更高，应尽可能避免。
