ASDIN 9th Annual Scientific Meeting

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Disclosure: No Conflict of InterestFrom: Vesely

Device

InfectionLead Entrapment

Malfunction

Fracture

Device

InfectionLead Entrapment

Malfunction

Fracture

• Transmission of infection from the leads to the stent

and from the stent to the lead

• Transmission of infection from the dialysis access to

the stent or the leads

• Transmission of infection from the pocket to the

stent and the leads

Description (Organism) Age

Race/

Gender Device GFR CKD/HD Antibiotic

Timing post

implant

Infected ICD pocket (Enterococcus) 66 B/F SC ICD 13.1 5/yes Vancomycin Admitted 4 days

Sepsis and prosthetic valve endocarditis

(Enterococcus) 52 B/M SC PM 86.3 5/yes Vancomycin Died 72 days

Mitral valve endocarditis (CNS/Fungus) 97 B/F DC PM 8.1 5/yes Cefazolin Died 6 weeks

Infected ICD lead; extracted (MRSA) 68 W/M BiV ICD 6.3 5/Yes Cefazolin 60 days

Pocket exploration for hematoma and

fevers; ICD ex- 80 W/M SC ICD 48 3/No Cefazolin <24 hours

Prosthetic valve endocarditis – died in

operating room 78 W/M DC PM 54.5 3/No Clindamycin 25 days

Infected ICD pocket (MRSA) 44 B/F SC ICD 90.7 1/No Clindamycin 60 days

Tompkins et al: J Cardiovasc Electrophsiol April 2011

ASDIN 9th Annual Scientific Meeting

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Asif et al: Semin Dial 2010

Data available at FDA website (TM Vesely)

Device

InfectionLead Entrapment

Malfunction

Fracture

ASDIN 9th Annual Scientific Meeting

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Saad et al. J Vasc Access 2010

Konner: Nephrol Dial Transplant 1997

Bolad et al. Catheterization and Cardiovascular Interventions 2005

Slonim et al. J Vasc Interv Radiol February 2000

Slide Courtesy:

Gerald Beathard

Heart Rhythm Society

has recommended against the use of stents

in this scenario

Wilkoff& Carrillo et al: Heart Rhythm 6:1085-1104, 2009

Baranowski et al: Hear Rhythm 2012

Carrillo R,…..Asif A: Am J Kidney Dis 55:1097-1101, 2010

Baranowski et al: Heart Rhythm 2012

Asif and Salman: Heart Rhythm 2012

ASDIN 9th Annual Scientific Meeting

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Device

InfectionLead Entrapment

Malfunction

Fracture

• 2 Leads in the left axillary vein (1997).

• Lead malfunction in 2007.

• 2 more leads in the axillary vein.

• AVF dysfunction and subclavian stenosis.

• Stent placement followed by lead fracture

• 2 more leads in the left axillary.

• MSSA infection.

• 4 leads were removed.

• 2 were left in place.

Baranowski et al: Hear Rhythm 2012

Saad et al: J Vasc Access: 11:293-302, 2010 Asif et al. Semin Dial 22:671-676, 2009

STENTS

N=14

PTA

N=29

18%

9%9%

45%

Average of

2.1 procedures / year

95%86%

73%

PTASTENTS

PTA

Saad et al:

J Vasc Access: 11:293-302, 2010Asif et al.

Semin Dial 22:671-676, 2009

Asif et al.

Semin Dial 22:671-676, 2009

PTA is

• Less invasive

• Avoids placement of another foreign body

• Provides similar patency rates

• Reduced cost

Vascular access stenosis is a recurrent problem

Lesions reappear at cephalic, caudal and intra-stent

Lesions reappear downstream or upstream from the stent

This would require insertion

of multiple stents Salman and Asif:

Kidney International 2011

ASDIN 9th Annual Scientific Meeting

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Asif et al: Semin Dial 2012

• Roger Carrillo, MD. CT surgery

• Gustavo Lopera, MD. Electro Physiology

• UrwaBarakat, M.D. Interventional Cardiology

• Rick Preston, M.D. Pharmacology

• Tony Salum, M.D. Infectious Diseases

• Roberto Vasquez Padron, PhD. Research Lab

• Students, residents and fellows in training.

• Loay Salman, M.D. Interventional Nephrology

• Donna Merrill, R.N. Interventional Nephrology