Sgroi Michael D, McFarland Graeme, Itoga Nathan K, Sorial Ehab, Garcia-Toca Manuel
Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
Ann Vasc Surg. 2019 Jan;54:66-71. doi: 10.1016/j.avsg.2018.10.003. Epub 2018 Oct 17.
Limited reports have documented the effect cardiac implantable electronic devices (CIEDs) have on arteriovenous (AV) access patency. Current recommendations suggest placing the access on the contralateral side of the CIEDs, as there is concern for increased central venous stenosis and access failure. The goal of this study is to review our single-center AV access patency rates for dialysis patients with an ipsilateral or contralateral side CIED.
A retrospective review was performed from 2008 to 2016 at a single institution identifying all patients who have received a CIED and the diagnosis of end-stage renal disease (ESRD). Medical records were queried to identify each patient's dialysis access and whether it was ipsilateral or contralateral to the CIED. Primary outcomes of study were primary and secondary patency rates.
A total of 44 patients were identified to have ESRD and CIED. Of these patients, 28 patients with fistulas or grafts (13 ipsilateral and 15 contralateral) had follow-up with regards to their AV access. There were 3 primary failures in both groups. For patients who had the CIED placed after already starting the dialysis, patency was based on when the cardiac device was implanted. Primary patency for ipsilateral and contralateral access was 20.2 and 22.2 months, respectively. With secondary interventions, ipsilateral and contralateral mean patency was 39 and 48.8 months, respectively. Six-month and 1-year primary patency for arteriovenous fistula or arteriovenous graft on patients with ipsilateral access was 69.2% and 53.8%, respectively. Ipsilateral 1-year cumulative patency was 39 months.
CIED may lead to stenosis or occlusion to one's AV access; however, primary assisted and secondary patency rates are still acceptable at 6 months and 1 year compared to Kidney Disease Outcomes Quality Initiative guidelines. Despite a CIED, a surgeon's algorithm should not lead to the abandonment of an ipsilateral access if the central venous system is patent.
关于心脏植入式电子设备（CIED）对动静脉（AV）通路通畅性影响的报道有限。目前的建议是将通路置于CIED的对侧，因为担心会增加中心静脉狭窄和通路失败的风险。本研究的目的是回顾我们单中心透析患者同侧或对侧植入CIED时的AV通路通畅率。
2008年至2016年在一家单一机构进行回顾性研究，确定所有接受CIED和终末期肾病（ESRD）诊断的患者。查询病历以确定每位患者的透析通路以及它与CIED是同侧还是对侧。研究的主要结局是初次和二次通畅率。
共确定44例患有ESRD和CIED的患者。在这些患者中，28例有动静脉内瘘或移植物的患者（13例同侧和15例对侧）对其AV通路进行了随访。两组均有3例初次失败。对于在开始透析后植入CIED的患者，通畅性取决于心脏设备的植入时间。同侧和对侧通路的初次通畅时间分别为20.2个月和22.2个月。经过二次干预后，同侧和对侧的平均通畅时间分别为39个月和48.8个月。同侧通路患者动静脉内瘘或动静脉移植物的6个月和1年初次通畅率分别为69.2%和53.8%。同侧1年累积通畅时间为39个月。
CIED可能导致患者的AV通路狭窄或闭塞；然而，与《肾脏病预后质量倡议》指南相比，6个月和1年时的初次辅助和二次通畅率仍可接受。尽管存在CIED，但如果中心静脉系统通畅，外科医生的手术方案不应导致放弃同侧通路。
