Division of Vascular Surgery, Stanford University, Stanford, Calif.
Division of Vascular Surgery, Stanford University, Stanford, Calif; Department of Surgery, University of California San Francisco-East Bay, Oakland, Calif.
J Vasc Surg. 2019 Oct;70(4):1242-1246. doi: 10.1016/j.jvs.2018.12.029. Epub 2019 Mar 6.
The number of patients with end-stage renal disease who require implantable cardiac devices is increasing. Rates of secondary interventions or fistula failure are not well studied in patients who have arteriovenous fistula (AVF) access placed on the ipsilateral side as a pacemaker. This study aimed to compare central vein-related interventions and failure rates of arteriovenous access in patients with pacemakers placed on the ipsilateral vs contralateral side.
A retrospective review of a prospectively collected database at a single high-volume dialysis institution was performed; all patients 18 years or older who had both arteriovenous access and a pacemaker were included. Data points included the number of interventions such as thrombectomy, percutaneous transluminal angioplasty, and stent placement, as well as time to first intervention and failure of the fistula or graft. Patients with an implantable cardiac device who had contralateral AVF access were compared with AVF ipsilateral access using a t-test and Kaplan-Meier curves for primary patency. Outcomes evaluated included number of interventions and time to intervention from access creation.
A total of 32 patients were identified; 20 had arteriovenous access on the contralateral side from the pacemaker and 12 had access on the ipsilateral side. In the contralateral group, there were a mean of 3.6 percutaneous transluminal angioplasties per patient (range, 1-12). In the ipsilateral group, there were an average of 2.8 percutaneous transluminal angioplasties per patient (range, 1-6). There was no difference in intervention rates between these cohorts; however, the time to intervention was increased in patients who had arteriovenous access on the contralateral side to their pacemaker (9.5 vs 19.5 months; P < .05). Patency rates did not differ (P = .068).
There was no difference in intervention rates between ipsilateral and contralateral patients; however, the time to intervention was increased in patients who had arteriovenous access on the contralateral side to their pacemaker (9.5 months vs 19.5 months). This study was limited by its lack of power. Patency rates did not differ (P = .068). Ipsilateral access placement should be considered rather than abandoning access in that extremity.
需要植入式心脏设备的终末期肾病患者数量正在增加。在同侧放置动静脉瘘（AVF）作为起搏器的患者中，二次干预或瘘管失败的发生率尚不清楚。本研究旨在比较同侧和对侧放置起搏器患者的中心静脉相关干预和动静脉通路失败率。
对单一大容量透析机构前瞻性收集数据库进行回顾性分析；所有年龄在 18 岁或以上且同时有动静脉通路和起搏器的患者均被纳入。数据点包括血栓切除术、经皮腔内血管成形术和支架置入等干预措施的数量，以及首次干预和瘘管或移植物失败的时间。使用 t 检验和Kaplan-Meier 曲线比较同侧和对侧 AVF 通路的患者，比较具有植入式心脏装置的患者和具有对侧 AVF 通路的患者，比较具有同侧 AVF 通路的患者。主要通畅率的评估结果包括从通路创建到干预的次数和时间。
共确定 32 例患者；20 例患者的起搏器对侧有动静脉通路，12 例患者同侧有动静脉通路。在对照组中，每位患者平均有 3.6 次经皮腔内血管成形术（范围为 1-12 次）。在同侧组中，每位患者平均有 2.8 次经皮腔内血管成形术（范围为 1-6 次）。这两组的干预率没有差异；然而，同侧有动静脉通路的患者的干预时间延长到他们的起搏器（9.5 个月对 19.5 个月；P<.05）。通畅率没有差异（P=0.068）。
同侧和对侧患者的干预率没有差异；然而，同侧有动静脉通路的患者的干预时间延长到他们的起搏器（9.5 个月对 19.5 个月）。本研究因缺乏动力而受到限制。通畅率没有差异（P=0.068）。应考虑同侧通路的放置，而不是放弃该肢体的通路。
