ASDIN: Patency Rates for Angioplasty in the Treatment of Pacemaker‐Induced Central Venous Stenosis in Hemodialysis Patients: Results of a Multi‐Center Study

Abstract

While hemodialysis access ligation has been used to manage pacemaker (PM) and implantable cardioverter-defibrillator (ICD) lead-induced central venous stenosis (CVS), percutaneous transluminal balloon angioplasty (PTA) has also been employed to manage this complication. The advantages of PTA include minimal invasiveness and preservation of arteriovenous access for hemodialysis therapy. In this multi-center study we report the patency rates for PTA to manage lead-induced CVS. Consecutive PM/ICD chronic hemodialysis patients with an arteriovenous access referred for signs and symptoms of CVS due to lead-induced CVS were included in this analysis. PTA was performed using the standard technique. Technical and clinical success was examined. Technical success was defined as the ability to successfully perform the procedure. Clinical success was defined as the ability to achieve amelioration of the signs and symptoms of CVS. Both primary and secondary patency rates were also analyzed. Twenty-eight consecutive patients underwent PTA procedure. Technical success was 95%. Postprocedure clinical success was achieved in 100% of the cases where the procedure was successful. The primary patency rates were 18% and 9% at 6 and 12 months, respectively. The secondary patency rates were 95%, 86%, and 73% at 6, 12, and 24 months, respectively. On average, 2.1 procedures/year were required to maintain secondary patency. There were no procedure-related complications. This study finds PTA to be a viable option in the management of PM/ICD lead-induced CVS. Additional studies with appropriate design and sample size are required to conclusively establish the role of PTA in the management of this problem.

Subcutaneous Implantable Cardioverter Defibrillator for Dialysis Patients: A Strategy to Reduce Central Vein Stenoses and Infections

“…22,23 Elevated venous pressure and high recirculation rates representing arteriovenous access dysfunction in patients with transvenous cardiac devices have been reported. 22 Drew et al 6 reported that angiography showed central vein stenoses in 21 of 34 (62%) patients. Most (n 5 17) of these were ipsilateral to the cardiac device.…”

“…The central venous stenosis can involve the subclavian and brachiocephalic veins, as well as the superior vena cava (Figs 1 and 2). 22 Although percutaneous balloon angioplasty and stent placement have been used to treat central venous stenosis, it frequently recurs. In a large multicenter study investigating angioplasty to treat central venous stenosis, primary patency rates were just 18% and 9% at 6 and 12 months, respectively.…”

Central venous obstruction and clinical predictors in patients with permanent pacemaker

“…Percutaneous transluminal balloon angioplasty and thrombolytic therapy has also been employed to manage this complication (15). Successful pacing lead implantation has been reported after angioplasty and stent dilation of superior vena cava and innominate vein obstructions (16).…”

Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

“…In a series of 14 ESRD patients with a pacemaker on the same side as AVF [11], 10 patients (71%) developed symptomatic venous hypertension and demonstrated subclavian vein stenosis or occlusion on angiography. Venous hypertension due to AVF and ipsilateral CIED leads has been in fact described in numerous other reports [14-18]. A possible explanation for SVC development beside vein injury during implantation is that repeated traumatization by leads in the vein wall is responsible for the progressive fibrotic stenosis just above the right atrium.…”