Timal Rohit J, Karalis Ioannis, Cabezas Jose M Montero, Rotmans Joris I, Hensen Liselotte C R, Buiten Maurits S, de Bie Mihaly K, van Erven Lieselot, Putter Hein, Schalij Martin J, Rabelink Ton J, Jukema J Wouter
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Cardiol Cardiovasc Med. 2022 Apr;6(2):171-188. doi: 10.26502/fccm.92920253. Epub 2022 Apr 14.
In hemodialysis patients, implantable cardioverter-defibrillator (ICD) implantation may result in central venous stenosis (CVS) with associated symptoms, such as pain, edema of the ipsilateral arm, facial edema, and loss of dialysis access. However, literature concerning CVS in dialysis patients with a cardiac implantable electronic device is scarce.
We conducted a prospective cohort study in which we investigated the incidence of CVS in end-stage renal disease patients on chronic dialysis who received an ICD as part of participation in the randomized ICD2 trial. A venography was performed before ICD implantation and at 1 year follow-up.
Between 2007 and 2017, 80 patients on dialysis received an ICD according to ICD2 trial protocol. Our population mainly consisted of males (76.3%), and had a median age of 67 years. Hemodialysis was the predominant dialysis modality (71.3%). The ICD was implanted in the right pectoral region in 58 patients (72.5%). A minority of the patients (27.5%) had a history of central venous catheters use, ipsilateral to ICD implantation site. Median follow-up was 16 months (IQR 13-35). Prospective assessment of central vein patency was possible in 56 patients (70.0%). Partial obstruction of central vein at follow-up was present in 19 out of 56 patients (33.9%) and complete occlusion in 4 patients (7.1%). With a complete clinical follow-up of all patients with a median duration of 3.5 years (IQR 2.7 - 6.3), 3 patients developed clinically significant symptoms of CVS.
Development of CVS in patients on chronic dialysis who received an ICD is a cause of concern. Prevention of such complications deserves attention and further research.
ISRCTN20479861.
在血液透析患者中，植入式心脏复律除颤器（ICD）植入可能导致中心静脉狭窄（CVS）并伴有相关症状，如疼痛、同侧手臂水肿、面部水肿以及透析通路丧失。然而，关于植入心脏植入式电子设备的透析患者发生CVS的文献较少。
我们进行了一项前瞻性队列研究，调查了作为随机ICD2试验一部分接受ICD的慢性透析终末期肾病患者中CVS的发生率。在ICD植入前和随访1年时进行静脉造影。
2007年至2017年期间，80例透析患者根据ICD2试验方案接受了ICD。我们的研究人群主要为男性（76.3%），中位年龄为67岁。血液透析是主要的透析方式（71.3%）。58例患者（72.5%）的ICD植入于右胸区域。少数患者（27.5%）有在ICD植入部位同侧使用中心静脉导管的病史。中位随访时间为16个月（四分位间距13 - 35个月）。56例患者（70.0%）能够进行中心静脉通畅情况的前瞻性评估。随访时，56例患者中有19例（33.9%）存在中心静脉部分阻塞，4例（7.1%）完全闭塞。在对所有患者进行了中位时长为3.5年（四分位间距2.7 - 6.3年）的完整临床随访后，3例患者出现了具有临床意义的CVS症状。
接受ICD的慢性透析患者发生CVS是一个值得关注的问题。预防此类并发症值得关注并进一步研究。
ISRCTN20479861
