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Development of Central Venous Stenosis Upon ICD Implantation in Dialysis Patients: A Non-Negligible Issue

Rohit J Timal1, Ioannis Karalis1, Jose M Montero Cabezas1

  • 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Cardiology and Cardiovascular Medicine
|August 26, 2022
PubMed

Insights

Central venous stenosis (CVS) affects over 40% of hemodialysis patients after implantable cardioverter-defibrillator (ICD) implantation. Further research is needed to prevent these complications in dialysis patients with cardiac devices.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Medicine

Background:

  • Implantable cardioverter-defibrillator (ICD) implantation in hemodialysis patients can lead to central venous stenosis (CVS).
  • Symptoms of CVS include pain, edema, and loss of dialysis access.
  • Literature on CVS in dialysis patients with cardiac implantable electronic devices is limited.

Purpose of the Study:

  • To investigate the incidence of central venous stenosis (CVS) in end-stage renal disease patients on chronic dialysis who received an ICD.
  • To assess the relationship between ICD implantation and the development of CVS.

Main Methods:

  • Prospective cohort study within the randomized ICD2 trial.
  • 80 dialysis patients received an ICD between 2007 and 2017.
  • Venography performed pre-ICD and at 1-year follow-up; clinical follow-up for symptoms.

Main Results:

  • 33.9% of patients (19/56) showed partial central vein obstruction, and 7.1% (4/56) had complete occlusion at 1 year.
  • Median follow-up was 16 months for venography and 3.5 years for clinical assessment.
  • Only 3 patients developed clinically significant CVS symptoms.

Conclusions:

  • Central venous stenosis (CVS) is a significant concern in dialysis patients following ICD implantation.
  • The findings highlight the need for preventative strategies and further research.
  • Monitoring central vein patency is crucial in this patient population.
Abstract

Keywords:
Cardiac device complicationCardiac implantable electronic deviceCentral venous stenosisEnd-stage renal diseaseICDImplantable cardioverter-defibrillatorLead-related central vein stenosisPhlebographyProspective studySubclavian vein stenosisVenographydialysis

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