Effect of Arteriovenous Hemodialysis Shunt Location on Cardiac Events in Patients Having Coronary Artery Bypass Graft Using an Internal Thoracic Artery

Abstract

The possibility of developing coronary steal in patients having coronary artery bypass graft (CABG) using internal thoracic artery (ITA) and ipsilateral upper extremity arteriovenous (AV) hemodialysis shunt has been reported. The impact of this phenomenon on clinical outcomes is uncertain. The aim of this study was to investigate an association between the AV dialysis shunt location regarding the side of the ITA CABG and clinical outcomes. This retrospective cohort study included chronic hemodialysis patients having ITA CABG and upper extremity AV shunt. The patients were divided into two groups: those with ipsilateral and those with contralateral location of ITA CABG and AV shunt. The outcomes were: death from any cause, cardiac death and a first cardiac event. In a group of 112 chronic hemodialysis patients having CABG, 32 had an ipsilateral and 25 had a contralateral location of ITA CABG and an upper extremity AV shunt. Significantly more cardiac events occurred in the group with an ipsilateral compared to a contralateral location of ITA CABGs and dialysis AV shunts (hazard ratio, 2.16 [95% CI, 1.11 to 4.19], P = 0.023). There was no difference between the groups in the all cause mortality risk (hazard ratio, 1.005 [95% CI, 0.43 to 2.37], P = 0.990) or the risk of cardiac death (hazard ratio, 2.43 [95% CI, 0.64 to 9.17], P = 0.191). The ipsilateral location of a CABG with the use of ITA and upper extremity AV hemodialysis shunt may be associated with increased risk of cardiac events.

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

“…This was associated with the development of clinical angina. We reported previously in our study on 57 HD patients with CABG and AV access elevated risk of cardiac events in ipsilateral group (8).…”

“…Recent reports, including one from our group (8), raise the possibility of a coronary steal when ITA CABG and an upper extremity AV access are located ipsilaterally (8–9–10). Other reports do not detect this effect (11–12–13).…”

Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass grafting

“…There are two conflicting reports of long-term clinical outcomes in patients with both functioning VA for hemodialysis and CABG with a functioning ITA graft. Feldman et al reported that upper-extremity VA for hemodialysis ipsilateral to an in situ ITA graft was associated with an increased risk of MACE during long-term follow-up [ 8 ]. On the other hand, Takami et al reported that use of an ITA graft ipsilateral to the VA did not increase the operative mortality or the risk of late death and MACE after CABG in patients undergoing hemodialysis [ 5 ].…”

Coronary-subclavian steal syndrome in a hemodialysis patient with ipsilateral subclavian artery occlusion and contralateral vertebral artery stenosis “Case Report”

“…Despite its excellent graft patency in patients who have previously undergone CABG surgery, cardiac events occur owing to ipsilateral SCA stenosis (coronary–subclavian steal phenomenon) ( 4 , 5 ). Feldman et al( 6 ) reported in their retrospective study that patients having IMA as CABG and ipsilateral upper extremity AVF are at increased risk of cardiac events. However, another report suggested that LIMA should be used whenever possible to avoid coronary–steal phenomenon during hemodialysis ( 7 ).…”