Authors
Kalinin R.E., Suchkov I.A., Egorov A.A., Klimentova E.A.
Ryazan State Medical University named after academician I.P. Pavlov, Ryazan
Abstract
Programmed hemodialysis, today, is the main method in the treatment of patients with terminal chronic kidney disease. For hemodialysis, the formation of a constant vascular access is necessary (as a rule, this is an arteriovenous fistula). One of the main reasons for the cessation of its functioning is thrombosis.
The aim of the study was to identify the causes of fistula thrombosis and the selection of optimal diagnostic and surgical correction methods.
Materials and methods. This study included 70 patients who had native arteriovenous fistulas formed for constant vascular access. Ultrasound duplex scanning and angiography according to indications were performed as diagnostics for all patients. A histological examination of stenoses of fistular veins and anastomoses was carried out. All patients underwent surgical treatment in the amount of thrombectomy, reconstruction of arteriovenous fistulas, or the formation of a new access.
Results. All patients were divided into three groups: — thrombosis on unchanged vessels — 5 patients (7%), thrombosis due to neointima hyperplasia, 25 patients (43%) at the sites of puncture of the fistular vein, thrombosis due to arterio-neointima hyperplasia venous anastomosis — 35 patients (50%).
These causes were identified using ultrasound duplex scanning and peripheral angiography. All patients underwent surgical treatment aimed at restoring constant vascular access. Plots of thrombosed veins and anastomoses underwent histological examination, where neointima hyperplasia was observed, which hemodynamically significantly narrowed the lumen of the vessel and caused thrombosis.
Conclusion In the course of the study, it was clinically and histologically confirmed that the main cause of thrombosis of the native arteriovenous fistula is neointimal hyperplasia, which requires mandatory surgical intervention.
Keywords: constant vascular access, arteriovenous fistula, hemodialysis, neointima, thrombosis.
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