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The Impact of Transvenous Cardiac Devices on Vascular Access Patency in Hemodialysis Patients

Authors

  • Chieh Suai Tan,

    1. Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Cui Jie,

    1. Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Jennifer Joe,

    1. Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Zubin D. Irani,

    1. Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Suvranu Ganguli,

    1. Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Sanjeeva Prasad Kalva,

    1. Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Stephan Wicky,

    1. Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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  • Steven Wu

    1. Vascular Imaging and Intervention Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2. Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    3. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
    4. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Address corresponding to:Steven Wu, MD, Director, Interventional Nephrology, Medical Director, Hemodialysis Vascular Access Program, Departments of Medicine & Radiology, Massachusetts General Hospital, Assistant Professor of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, Tel.: +781-726-8315, Fax: 617-726-8476, or e-mail: wu.steven@mgh.harvard.edu.

Abstract

Creating a vascular access in the presence of a cardiovascular implantable electronic device (CIED) in a patient with or approaching end-stage renal disease can be challenging. In this study, we aimed to evaluate the impact of a CIED on the outcomes of vascular access creation in hemodialysis patients and determine their effects on vascular access patency. This is a single-center retrospective review of hemodialysis patients who underwent vascular access creation after CIED placement. Outcomes of vascular access creation and need for endovascular interventions were compared between patients with vascular access created ipsilateral and contralateral to the site of CIED. Comparing patients with arteriovenous (AV) access created ipsilateral to CIED placement (= 19) versus the contralateral side (= 17), the primary failure rate was 78.9% versus 35.3% (= 0.02). For AV accesses that were matured, the median primary patency durations for AV accesses created ipsilateral to the CIED was 11.2 months compared to 7.8 months for AV accesses created contralateral to the CIED (= 1.00). AV accesses created ipsilateral to a CIED have a higher primary failure rate compared with the contralateral arm and should be avoided as much as possible.

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