Abstract
Vascular access is the cornerstone of hemodialysis. With vascular access dysfunction, the results of treatment of patients with stage 5 chronic kidney disease significantly deteriorate. One of the most common causes of vascular access failure is peripheral venous stenosis. Despite the variety of initiating factors, the morphological substrate of stenotic damage to the arteriovenous fistula (or arteriovenous anastomosis) in most cases is neointimal hyperplasia. Stenotic lesions of the arterivenous fistula are strongly associated with an increased risk of thrombosis and loss of vascular access. There are 4 typical localizations of stenosis: arteriovenous or arteriograft anastomosis, stenosis of the juxta-anastomotic segment of the fistula, stenosis of the functional segment of the fistula, and stenosis of the cephalic arc.The most common indication for surgical treatment is vascular access failure; less common indications are clinical symptoms of venous insufficiency.There are various methods of open reconstruction of the stenotic segment of the fistula vein: resection, prosthetics with a synthetic vascular graft, prosthetics or plastic repair of the autologous vein wall, complete or partial drainage of the prestenotic segment of the vein, etc. Currently an alternative method of stenosis repair using endovascular interventions is gaining popularity. In contrast to central vein stenosis, where endovascular interventions are the gold standard, in peripheral vein stenosis it is only an adjuvant method. Complications of endovascular interventions are extremely rare.Despite the fact that endovascular interventions have almost absolute probability of technical success, the primary patency is not high and is about 50% in six months. The use of bare stents is not accompanied by an increase in primary patency. The use of stent-grafts can increase the primary patency, especially in the plastic repair of challenging stenoses of the graft-vein anastomosis or cephalic arch.Many issues related to endovascular interventions remain unresolved, which requires further research.
Highlights
The most common indication for surgical treatment is vascular access failure; less common indications are clinical symptoms of venous insufficiency
The use of bare stents is not accompanied by an increase in primary patency
Authors informationKardanakhishvili Zurab B., Postgraduate Student, Department of Transplantology, Nephrology and Artificial Organs, Moscow Regional Research and Clinical Institute, Moscow, Russian Federation. Zulkarnaev Alexey B., DM, Principal Researcher, Surgical Department of Transplantation and Dialysis, Moscow Regional Research and Clinical Institute, Moscow, Russian Federation. ORCID iD 0000-0001-5405-7887
Summary
Открытые и эндоваскулярные оперативные вмешательства при стенозе периферических отделов фистульных вен Карданахишвили З.Б., Зулькарнаев А.Б. При дисфункции сосудистого доступа значительно ухудшаются результаты лечения пациентов с хронической болезнью почек V стадии. Одной из наиболее частых причин дисфункции сосудистого доступа является стеноз периферического отдела фистульной вены. Несмотря на многообразие инициирующих факторов, морфологическим субстратом стенотического поражения фистульной вены (или артериовенозного анастомоза) в большинстве случаев является неоинтимальная гиперплазия. Стенотическое поражение фистульной вены сильно ассоциировано с повышенным риском тромбоза и утратой сосудистого доступа. В отличие от стенозов центральных вен, где эндоваскулярные вмешательства являются золотым стандартом, при стенозе периферических вен это лишь адъювантый метод. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи. Открытые и эндоваскулярные оперативные вмешательства при стенозе периферических отделов фистульных вен.
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