ASDIN 9th Annual Scientific Meeting · Asif et al: SeminDial 2010 Data available at FDA website (TM...
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ASDIN 9th Annual Scientific Meeting 1 Disclosure: No Conflict of Interest From: Vesely Device Infection Lead Entrapment Malfunction Fracture Device Infection Lead 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
Transcript of ASDIN 9th Annual Scientific Meeting · Asif et al: SeminDial 2010 Data available at FDA website (TM...
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
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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
