Year 2020 Vol. 28 No 5

GENERAL & SPECIAL SURGERY

Z.B. KARDANAKHISHVILI 1, 2, A.B. ZULKARNAEV 1, V.V. ROGOZIN 3, V.A. STEPANOV 1

STENTING AND ISOLATED BALLOON ANGIOPLASTY FOR CENTRAL VENOUS STENOSIS IN PATIENTS UNDERGOING HEMODIALYSIS

Moscow Regional Research and Clinical Institute Named after M.F.Vladimirsky 1
M. E. Zhadkevich Moscow City Clinical Hospital of the Department of Health Care of Moscow 2
Moscow Hospital No2 for War Veterans of the Department of Health Care of Moscow 3, Moscow,
The Russian Federation

Objective. To carry out comparative analysis of the results of isolated balloon angioplasty (BA) and BA with stenting of the central venous stenosis (CVS) in patients undergoing hemodialysis .
Methods. A retrospective study included patients (n=62) with CVS. The isolated BA was performed in 39 patients. Stenting was added to isolated BA in 23 patients.
Results. Primary functional patency of the arteriovenous fistula after 1 and 3 years in the BA group was 89.7% [95%CI 74.9; 96] and 30.8% [95%CI 17.3; 45.4]; after stenting: 100% and 30.4% [95%CI 13.5; 49.3]; HR=0.8756 [95%CI 0.527; 1455], p=0.5994. Primary patency after 6 and 12 months in the BA group was 61.5% [95%CI 44.5; 74.7] and 15.4% [95%CI 6.2; 28.3]; after stenting: 82.6% [95%CI 60.1; 93.1] and 47.8% [95%CI 26.8; 66.1]; HR=0.4845 [95%CI 0.2938; 0.799], p=0.0017. Secondary functional patency after 1, 3 and 5 years in the BA group was 100%, 74.4% [95%CI 57.6; 85.3] and 12.8% [95%CI 4.7; 25.2]; after stenting: 100%, 91.3% [95%CI 69.5; 97.8] and 34.8% [95%CI 16.6; 53.7]; HR=0.4764 [95% CI 0.2888; 0.786], p=0.0016. Secondary patency after 6, 12 and 24 months in the BA group was 84.6% [95%CI 68.9; 92.8], 66.7% [95%CI 49.6; 79.1] and 17.9% [95%CI 7.9; 31.3]; after stenting: 91.3% [95%CI 69.5; 97.8], 78.3% [95%CI 55.4; 90.3] and 43.5% [95%CI 23.3; 62.1]; HR=0.4925 [95%CI 0.2988; 0.8119], p=0.0021. Correlation between primary functional patency and primary patency was r= -0.627; p<0.0001, between primary functional patency and secondary patency r= -0.53; p=0.0005 in the BA group; after stenting: r= -0.351; p=0.101 and r= -0.304; p=0.159, respectively.
Conclusion. The results of BA significantly depend on the stage stenosis. The use of stenting can slightly improve the results regardless the CVS terms.

Keywords: vascular access, central veinous stenosis, hemodialysis, chronic kidney disease, endovascular surgery, balloon angioplasty, stenting
p. 515-526 of the original issue
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Address for correspondence:
129110, Russian Federation,
Moscow, Shchepkin str, 61/2, 6,
tel.: +7-916-705-98-99,
e-mail: 7059899@gmail.com,
Zulkarnaev Alexey B.
Information about the authors:
Kardanakhishvili Zurab B., Post-Graduate Student of the Department of Transplantation, Nephrology and Artificial Organs of the Faculty of Advanced Training, Moscow Regional Research and Clinical Institute named after M.F.Vladimirsky, Surgeon of the Department of Vascular Surgery, M. E. Zhadkevich Moscow City Clinical Hospital, Moscow, Russian Federation.
https://orcid.org/0000-0001-9739-6432
Zulkarnaev Alexey B., Leading Researcher, the Surgical Department of Kidney Transplantation, Moscow Regional Research and Clinical Institute Named after M.F.Vladimirsky, Moscow, Russian Federation.
https://0000-0001-5405-7887
Rogozin Vasily V., Surgeon of the Department of Vascular Surgery, Moscow Hospital No2 for War Veterans of the Department of Health Care of Moscow, Moscow, Russian Federation.
https://0000-0003-4870-6400
Stepanov Vadim A., Senior Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research and Clinical Institute named after M.F.Vladimirsky, Moscow, Russian Federation.
https://0000-0002-0881-0599
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