대한신장학회

논문분류	춘계학술대회 초록집
제목	Central Venous Angioplasty Across a Cardiac Defibrillator Lead in a Hemodialysis Patient with Ipsilateral Arm Swelling
저자	Soh Yeon Kim
출판정보	2026; 2026(1):
키워드	Central venous stenosis, Cardiac implantable electronic device, Percutaneous transluminal angioplasty, Vascular access
초록	Case Study: An 80-year-old woman receiving maintenance hemodialysis through a left brachiocephalic arteriovenous fistula presented with progressive dialysis-arm swelling and prominent chest-wall collateral veins, suggesting venous hypertension from central venous outflow obstruction. She had a cardiac implantable electronic device (implantable cardioverter-defibrillator with cardiac resynchronization therapy) with a lead coursing through the left innominate vein. Fistulography demonstrated severe focal stenosis of the left innominate vein at the lead-crossing segment with delayed central drainage and collateralization. Because angioplasty across a device lead may risk lead injury or device malfunction, cardiology co-management was arranged. Pre-procedural device interrogation confirmed stable sensing, pacing thresholds, and lead impedance. Percutaneous transluminal angioplasty was performed using a conservative inflation strategy emphasizing slow, stepwise pressure escalation and avoidance of high-pressure extremes. A 6 × 60 mm high-pressure balloon was inflated from 10 atm (nominal) up to 16 atm (rated burst pressure 24 atm), deliberately stopping below the rated pressure. Residual stenosis was further treated with an 8 × 40 mm high-pressure balloon inflated from 8 atm (nominal) up to 12 atm, also below its rated burst pressure. During each inflation, pressure was increased gradually with short holds at each step to minimize abrupt mechanical stress on the lead. Final angiography showed improved luminal caliber, faster contrast clearance, and reduced collateral filling. Immediate post-procedural device interrogation demonstrated no change in lead parameters or device function; no arrhythmic events or inappropriate shocks occurred. The patient’s arm swelling and collateral vein prominence improved, allowing continued hemodialysis via the existing access. This case illustrates that central venous angioplasty traversed by a cardiac implantable electronic device lead can be performed safely in a hemodialysis patient when a standardized protocol is applied, including cardiology co-management, pre- and post-procedure device interrogation, and slow, stepwise inflation below rated pressure limits.
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