Conclusions

This case suggests that delayed AVF maturation may occur in the absence of angiographically apparent central venous stenosis in patients with ipsilateral transvenous ICD leads. The temporal association between lead extraction and subsequent clinical improvement raises the possibility that lead-related flow disturbance may have contributed alongside reduced cardiac function, accessory venous branches, vascular geometry, and the uremic milieu. Because direct hemodynamic measurements were unavailable and delayed natural maturation or the effect of prior accessory-vein embolization cannot be excluded, this observation should be considered hypothesis-generating. Prospective studies incorporating serial access-flow measurements, objective hemodynamic assessment, and clinical usability outcomes are needed to determine whether lead-related flow disturbance influences AVF maturation and should inform ICD platform selection in dialysis-dependent patients.