Axillary pacemaker generator implantation and direct axillary vein puncture on the infected side for a pacemaker infection on the opposite side to an arteriovenous fistula in a dialysis patient

[Background] In dialysis patients, the implantation of devices on the same side as the arteriovenous fistula (AV fistula) is contraindicated; thus, they are implanted on the opposite side. If a device infection occurs, it is recommended that the system should be completely removed and re-implanted. However, the optimal re-implantation site in cases involving dialysis patients is unclear. [Case] The patient was a 72-year-old male dialysis patient. He had a left-sided AV fistula. After a pacemaker was implanted in the right precordial region, he developed sepsis from a gastrointestinal tract infection, which led to a device infection. [Progress] After the removal of the entire system, the main body of the system was placed in the right axillary pocket and direct puncture of the right axillary vein was performed. [Results] In a dialysis patient with a device infection, performing axillary pacemaker generator re-implantation and direct puncture of the axillary vein on the infected side was considered useful, as it ensured that the pacemaker generator was placed as far as possible from the infected pocket and the leads did not overlap with the locations of the removed leads.