References


1. Spittell PC, Hayes DL. Venous complications after insertion of a transvenous pacemaker. Mayo Clin Proc. 1992;67:258–265.


2. Oginosawa Y, Abe H, Nakashima Y. The incidence and risk factors for venous obstruction after implantation of transvenous pacing leads. Pacing Clin Electrophysiol. 2002;25:1605–1611.


3. Abu-El-Haija B, Bhave PD, Campbell DN, Mazur A, Hodgson-Zingman DM, Cotarlan V, et al. Venous stenosis after transvenous lead placement: A study of outcomes and risk factors in 212 consecutive patients. J Am Heart Assoc. (2015)4:e001878. doi: 10.1161/JAHA.115.001878.


4. Lickfett L, Bitzen A, Arepally A, Nasir K, Wolpert C, Jeong KM, et al. Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace. (2004) 6:25–31. doi: 10.1016/j. eupc.2003.09.001.


5. Korzets A, Chagnac A, Ori Y, Katz M, Zevin D. Subclavian vein stenosis, permanent cardiac pacemakers and the haemodialysed patient. Nephron 1991;58:103–5.


Balancing the theoretical risk of possible need for future CIED lead extraction versus immediately preserving HD access is a discussion that should be had with the patient and their care team.


the CIED leads. Lesions that failed to respond to angioplasty with >30% residual stenosis or short interval (3 month) restenosis were considered for stenting. Primary patency at 6 and 12 months was 45% and 9% respectively. Secondary patency rates were 100% and 90% at 12 and 6 months. Mean number of interventions per patient per year was 2.1. There was no CIED device dysfunction or lead failure after stenting. No patient required cardiac rhythm device removal or exchange.9


The obvious concern with stenting over CIED leads are damage to leads and “entrapping” leads, making future extraction very challenging. The authors argue that leads are manufactured with a very robust multilayered coating that is quite resistant to mechanical damage. Lead entrapment becomes an issue when a patient has endovascular infection or failed antibiotics and laser removal of leads becomes impossible, thus requiring an open surgical procedure. While this is true, it is discussed that with the high mortality rate associated with HD patients, long-term survival may not be


20 IRQ | FALL 2023


achievable. In these situations, keeping the patient out of the hospital, reducing the number of procedures, preserving their AV access and reducing morbidity of venous catheter placements should be of utmost importance.9


Balancing


the theoretical risk of possible need for future CIED lead extraction versus immediately preserving HD access is a discussion that should be had with the patient and their care team.


New devices and “leadless pacemakers” placed via transfemoral approach into the right ventricle may be an alternative to the traditional transvenous pacemakers and can decrease lead- associated CVS in HD patients. Leadless pacemakers, however, have limited pacing modalities and memories, so use of these devices will depend on the clinical indication for pacing.10


It is therefore essential that


when caring for complex HD access patients who require CIEDS there is a multidisciplinary discussion between electrophysiologists, vascular access surgery and interventional radiologists prior to device placement, AVF creation or interventions.


6. Teruya TH, Abou-Zamzam AM, Limm W, Wong L, Wong L. Symptomatic subclavian vein stenosis and occlusion in hemodialysis patients with transvenous pacemakers. Ann Vasc Surg. 2003; 17: 526–9.


7. Domenichini G, Le Bloa M, Carroz P, Graf D, Herrera-Siklody C, Teres C, Porretta AP, Pascale P, Pruvot E. New Insights in Central Venous Disorders. The Role of Transvenous Lead Extractions. Front Cardiovasc Med. 2022 Feb 23;9:783576. doi: 10.3389/fcvm.2022.783576. PMID: 35282352; PMCID: PMC8904723.


8. Asif A, Salman L, Carrillo RG, Garisto JD, Lopera G, Barakat U, Lenz O, Yevzlin A, Agarwal A, Gadalean F, Sachdeva B, Vachharajani TJ, Wu S, Maya ID, Abreo K. Patency rates for angioplasty in the treatment of pacemaker-induced central venous stenosis in hemodialysis patients: Results of a multi-center study. Semin Dial. 2009 Nov-Dec;22(6):671-6. doi: 10.1111/j.1525- 139X.2009.00636.x. Epub 2009 Oct 2. PMID: 19799756.


9. Saad TF, Myers GR, Cicone J. Central vein stenosis or occlusion associated with cardiac rhythm management device leads in hemodialysis patients with ipsilateral arteriovenous access: a retrospective study of treatment using stents or stent-grafts. J Vasc Access. 2010 Oct-Dec;11(4):293–302. doi: 10.5301/jva.2010.1064. PMID: 20658455.


10. El-Chami MF, Clementy N, Garweg C, Omar R, Duray GZ, Gornick CC, Leyva F, Sagi V, Piccini JP, Soejima K, Stromberg K, Roberts PR. Leadless pacemaker implantation in hemodialysis patients: Experience with the Micra Transcatheter pacemaker. JACC Clin Electrophysiol. 2019 Feb;5(2):162–170. doi: 10.1016/j.jacep.2018.12.008. Epub 2019 Jan 30. PMID: 30784685.


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