Observation of swollen hand syndrome caused by arteriovenous fistula and pacemaker on the same side and the effect of endovascular therapy

Objective To observe whether the arteriovenous fistulas(AVF)and pacemakers on the same side are prone to cause swollen hand syndrome and to observe the effect of endovascular therapy. Methods Experimental group:10 patients with arteriovenous fistulas on the same side of pacemaker;control group:10 patients with arteriovenous fistulas on the opposite side of pacemaker.Observation:(1)Whether there is a history of dialysis catheter insertion in jugular vein or subclavian veinon the side of arteriovenous fistula;(2)How long the limb swelling on the fistula side lasts after a pacemaker is placed on the same side after AVF or with AVF under the condition of existence of a pacemaker lead;(3)Central vein stenosis or occluded site;(4)Endovascular therapy;(5)When it recurs after endovascular therapy;(6)Whether percutaneous transluminal angioplasty(PTA)affects pacemaker function. Results In the experimental group:eight patients started to develop limb swelling after co-existence of AVF and pacemaker on the same side for 17.0(2.6,30.0)months;one patient experienced fistular occlusion after co-existence of AVF and pacemaker on the same side for 3.5 years,and did not need to intervene because of mild limb swelling on the side of fistula before occlusion;one patient had no limb swelling after co-existence of AVF and pacemaker on the same side for 4.5 years.For the treatment,two patients underwent AVF once again on the opposite side,and the fistula on the affected side was closed after maturation of the new fistula. Six patients were treated with PTA alone ten times in total.The interval from PTA alone to swelling recurrence was(6.0±4.9)months,and no stent was implanted in all patients.Pacemaker function was normal after PTA.Control group:By the end point of observation,all patients had no swelling of the limbs on the side of arteriovenous fistula. Conclusions When arteriovenous fistula and pacemaker are located on the same side,swollen hand syndrome is relatively easy to occur.The effect of simple PTA for central venous lesions is relatively poor,stents are not recommended.Short term observation shows that balloon dilation has no significant effect on the function of a pacemaker lead.