Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.
Division of Nephrology and Dialysis, ASST Monza, Desio and San Gerardo Hospital, Milan, Italy.
Int Urol Nephrol. 2021 Dec;53(12):2541-2548. doi: 10.1007/s11255-021-02830-w. Epub 2021 Mar 16.
The benefits from cardiovascular implantable electronic devices (CIED) implantation in hemodialysis (HD) patients are still far to be thoroughly defined, especially on primary prevention. In addition, CIED placement is not a risk-free procedure, because it could be followed by a not negligible burden of complications that could compromise the health and the vascular access of HD patients. In fact, the arteriovenous fistula (AVF) dysfunction following CIED implantation is usually due to a hemodynamically significant alteration of blood flow. This condition could lead to a potential decrease of dialysis efficacy and a raised risk of thrombosis of both the central vein and the efferent vein of the AVF.The pathological pathway that leads to AVF dysfunction after CIED implantation may involve the irritating actions of the CIED and their leads to the vascular wall in HD patients that are more prone to show previous vascular diseases.The aim of this review is to focus the physiopathology of the CIED-induced AVF dysfunction, the current treatment strategies and the novel perspectives that could be taken into consideration and offered to the HD population to preserve both their AVF and their quality of life.
心血管植入式电子设备（CIED）在血液透析（HD）患者中的获益仍远未得到充分明确，尤其是在一级预防方面。此外，CIED 放置并不是一个无风险的过程，因为它可能会带来不可忽视的并发症负担，从而损害 HD 患者的健康和血管通路。事实上，CIED 植入后动静脉瘘（AVF）功能障碍通常是由于血流的血液动力学显著改变引起的。这种情况可能导致透析效果降低，并增加 AVF 的中心静脉和流出静脉的血栓形成风险。导致 CIED 植入后 AVF 功能障碍的病理途径可能涉及 CIED 及其导线对 HD 患者血管壁的刺激作用，这些患者更容易出现先前的血管疾病。本综述的目的是关注 CIED 引起的 AVF 功能障碍的病理生理学，目前的治疗策略以及可能被考虑并提供给 HD 人群以保留其 AVF 和生活质量的新视角。
