Title: Cardiovascular implantable electronic devices and native arteriovenous fistula in hemodialysis patients: novel perspectives.

Abstract: The benefits from cardiovascular implantable electronic devices (CIED) implantation in hemodialysis (HD) patients are still far to be thoroughly defined, especially on primary prevention. In addition, CIED placement is not a risk-free procedure, because it could be followed by a not negligible burden of complications that could compromise the health and the vascular access of HD patients. In fact, the arteriovenous fistula (AVF) dysfunction following CIED implantation is usually due to a hemodynamically significant alteration of blood flow. This condition could lead to a potential decrease of dialysis efficacy and a raised risk of thrombosis of both the central vein and the efferent vein of the AVF.The pathological pathway that leads to AVF dysfunction after CIED implantation may involve the irritating actions of the CIED and their leads to the vascular wall in HD patients that are more prone to show previous vascular diseases.The aim of this review is to focus the physiopathology of the CIED-induced AVF dysfunction, the current treatment strategies and the novel perspectives that could be taken into consideration and offered to the HD population to preserve both their AVF and their quality of life.

Source：Spatola L, Rivera RF, Mugnai G. Cardiovascular implantable electronic devices and native arteriovenous fistula in hemodialysis patients: novel perspectives[J]. Int Urol Nephrol, 2021,DOI: 10.1007/s11255-021-02830-w.

摘要： 植入心血管植入式电子装置(CIED)对血液透析(HD)患者的益处，尤其是在一级预防方面，仍有待彻底确定。此外，CIED植入术也不是一种无风险的手术，因为它可能会带来不可忽视的并发症负担，从而危及血液透析患者的健康和血管通路。事实上，CIED植入后的动静脉瘘(AVF)功能障碍通常是由于血流动力学的显著改变。这种情况可能会导致透析效率的潜在下降，并增加AVF中心静脉和回路静脉血栓形成的风险。CIED植入后导致AVF功能障碍的病理途径可能涉及CIED的刺激作用于血管壁，更容易出现在既往血管疾病的血液透析患者身上。本综述的目的是关注CIED诱发的AVF功能障碍的病理生理学、当前的治疗策略和可考虑的新观点，并提供给HD人群以保护他们的AVF和生活质量。

启发：了解CIED的优劣，为需要进行CIED置入的患者选择合适的方案，结合适宜的AVF设计，以期获取更好地效果。