nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-423Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESСтенозы центральных вен у пациентов, находящихся на хроническом гемодиализе, от этиологии до лечения (Обзор литературы)Central vein stenosis in patients on chronic hemodialysis, from etiology to treatment (Literature review)ГаринЮ. Ю.GarinYu. Yu.yuyu84@mail.ruАсадулаевШ. М.AsadulaevSh. M.noemail@neicon.ruСуховВ. К.SukhovV. K.noemail@neicon.ruРяснянскийВ. Ю.RyasnyanskiyV. Yu.noemail@neicon.ruСЗГМУ им. И.И. МечниковаРоссияClinic. I.I. Mechnikov North-western State Medical UniversityRussian FederationСПб ГБУЗ «Городская многопрофильная больница №2»РоссияMunicipal hospital № 2Russian Federation2016190820241813539Copyright © Гарин Ю.Ю., Асадулаев Ш.М., Сухов В.К., Ряснянский В.Ю., 20242024Гарин Ю.Ю., Асадулаев Ш.М., Сухов В.К., Ряснянский В.Ю.Garin Y.Y., Asadulaev S.M., Sukhov V.K., Ryasnyanskiy V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/423

Стеноз центральной вены является одной из главных причин дисфункции сосудистого доступа у пациентов, находящихся на хроническом гемодиализе. Данная патология имеет широкое распространение, вызывая у врачей вопросы относительно тактики ведения данных пациентов. Основной причиной стенозов центральных вен является использование катетеров для проведения диализа. В связи с этим, формирование артериовенозной фистулы перед началом хронического гемодиализа во избежание необходимости постановки диализного катетера является главной мерой профилактики стеноза центральных вен. Как правило, клинические симптомы (отек конечности и грудной клетки, боль в руке и появление подкожных коллатералей) возникают после наложения артериовенозной фистулы или протеза. Во время диализа отмечается повышение венозного давления и рециркуляции, увеличение времени гемостаза после удаления диализной иглы. На сегодняшний день эффективных консервативных методов лечения нет. Достоверными методами диагностики являются МСКТ и ангиография. Несмотря на высокую частоту рестеноза, внутрисосудистая коррекция (баллонная ангиопластика и стентирование) является методом выбора относительно хирургической (различные варианты шунтирования). В данной статье вкратце изложены этиологические причины развития данной патологии, меры профилактики, диагностики и лечения стенозов центральных вен.

Central vein stenosis is a reason of dysfunction of vascular access in patients on chronic hemodialysis. This disease is widespread. A question how to treat these patients is open. The main reason of central vein stenosis is the use of hemodialysis catheters. Therefore, the only way to prevent a damage of central vein is the forming of arteriovenous fistula before start of chronical hemodialysis instead of using of hemodialysis catheters. As a rule, clinical signs (edema of ipsilateral upper extremity and breast, pain in an arm and the development of subcutaneous collaterals) appear after creation of fistula or graft. During a dialysis session, there are high venous pressures, increased recirculation and increased hemostasis time with the removal of the dialysis needles. Nowadays, there is no effective non-surgical method of treatment. The most informative methods of diagnosis are angiography and MSCT venography. Despite of high incidence of restenosis, endovascular intervention (balloon angioplasty and stenting) is the preferable method of correcting central vein stenosis to surgical one (various methods of bypass grafting). The article provides is some information about etiology, prophylaxis, diagnosis and treatment of this condition.

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The authors declare that there are no conflicts of interest present.