THROMBOSIS OF ARTERIO-VENOUS FISTULA: QUESTION OF FEASIBILITY OF PERFORMING THROMBECTOMY

Abstract

Abstract. Introduction. Thanks to the use of renal replacement therapy at the current stage of medical development, full medical and social rehabilitation of patients with end-stage chronic renal failure is possible. The key to effective programmed hemodialysis is the formation of adequate permanent vascular access. Ensuring the optimal use and functioning of vascular access is a multidisciplinary problem. Currently, none of the known options for access is ideal, but the native arteriovenous fistula meets the requirements to a great erextent. Complications from vascular access for hemodialysis remain relevant for their solution today. The most common complication of vascular access is arteriovenous fistula thrombosis. For patients with end-stage renal failure who are on programmed hemodialysis, thrombosis of vascular access is a great danger, which ultimately can lead to the impossibility of further hemodialysis and it is the main reason for hospitalization and high mortality of this contingent of patients and needs an urgent solution. Purpose of the work improving the immediate and long-term outcomes of patients receiving programmed hemodialysis treatment by determining the feasibility of thrombectomy for early and late arteriovenous fistula thrombosis in the postoperative period as a method of ensuring the effective functioning of the permanent vascular access. Materials and methods. A retrospective analysis of the clinical data of 17 patients who underwent thrombectomy from a subcutaneous “fistula” vein of the upper extremity was performed. The age of the patients was 49.0 (44.0-61.0) years. By gender, the studied patients were distributed as follows: women - 9 (53 %), men - 8 (47 %). Among 17 (100 %) operated patients, 12 (71 %) had late thrombosis, 5 (29%) had early arteriovenous fistula thrombosis. Results. Of 5 (100 %) patients with early arteriovenous fistula thrombosis, thrombectomy was effective in 2 (40 %) patients (p=0.038). On the other hand, in 12 (100 %) patients with late fistula thrombosis, thrombectomy was successful in only 4 (33 %) cases. Conclusions. Neointimal hyperplasia is the main cause of progressive arteriovenous fistula stenosis and subsequent thrombosis. Thrombectomy is indicated for fistula thrombosis in the early postoperative period (up to 30 days after formation the last one). Thrombectomy alone is not enough to restore the patency of the permanent vascular access in the long term, and the final treatment requires its reconstruction at an early stage or the creation of a new arteriovenous fistula.