Massive arm edema following arteriovenous dialysis shunt creation in a patient with ipsilateral permanent pacemaker.
Asymptomatic subclavian vein occlusion following insertion of a permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) is not uncommon. We report a case of a dual-chamber PPM in a patient with an unrecognized left subclavian vein occlusion who developed massive left arm edema following ipsilateral implantation of an arteriovenous (AV) hemodialysis graft. We recommend that patients with pre-existing PPM or ICD leads who are in need of vascular access for hemodialysis should have the AV shunts placed in the contralateral arm. If this is unavoidable, then preoperative subclavian vein screening for patency should be mandatory, even in asymptomatic patients. Sonography is an appropriate initial test in such a situation.
Maher
James
J
Department of Medicine, New Jersey Medical School, University of Medicine and Dentistry, 185 South Orange Avenue, Newark, NJ 07103, USA.
Rivero
Abel
A
Zaim
Sina
S
Pappas
Peter J
PJ
Labropoulos
Nicos
N
Klapholz
Marc
M
Saric
Muhamed
M
D000368:Aged; D001132:Arm; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging