How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies. (28th October 2022)

• Record Type: Journal Article
• Authors: Czajkowski, Marek; Polewczyk, Anna; Jacheć, Wojciech; Nowosielecka, Dorota; Tułecki, Łukasz; Stefańczyk, Paweł; Kutarski, Andrzej
• Is Part Of: Clinical physiology and functional imaging. Volume 43:Number 1(2023)
• Page Start: 47
• Page End: 57
• Publication Date: 2022-10-28
• Subjects: dialysis -- electrodes -- pacemaker -- thoracic veins; Physiology, Pathological -- Periodicals; Diagnostic imaging -- Periodicals; 612
• DOI: 10.1111/cpf.12792
• Languages: English
• ISSNs: 1475-0961

Abstract

Abstract: Patients requiring temporal or permanent catheter or arterio‐venous fistula (AVF) for haemodialysis may be in challenging situation, if they are cardiovascular implantable electronic devices (CIED) carriers. Materials and Methods: The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. Results: A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. Conclusion: (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free‐from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally.