Transluminal balloon angioplasty in the treatment of central vein stenoses and arteriovenous fistulas: immediate and long-term results

Aim. To analyze the first experience of using transluminal balloon angioplasty (TBA) in the treatment of central vein stenosis (CVS), arteriovenous fistula (AVF) stenosis, to evaluate the safety and efficacy of this technique, to study the long-term consequences of balloon angioplasty. Material and methods. From January 2020 to July 2022, 71 endovascular balloon angioplasty procedures were performed to treat vascular access dysfunction. In 30 (42%) patients who made up the first observation group, the cause of vascular access (VA) dysfunction was CVS, in 41 patients (58%), who made up the second observation group, the cause of dysfunction was AVF stenosis. In each of the groups, we assessed the immediate and long-term results of balloon angioplasty in terms of technical effectiveness (the possibility of passing through the zone of stenosis with a wire guide and performing TBA), technical success (less than 30% residual stenosis after TBA), recurrence rate, and primary AVF patency. Results. In the first group (CVS), the median percentage of stenosis before the intervention was 90 (IQR: 80-95)%, and after angioplasty it was 25 (IQR: 15-45)%. Technical efficiency was 93.3% (28/30), and technical success was 53.3% (16/30). The primary patency of the central vein within 3, 6, and 12 months was 87.2%, 74.5%, and 39.0%, respectively. In the second group (AVF stenosis), the median percentage of stenosis before the intervention was 80 (IQR: 75-90)%, and after angioplasty it was 10 (IQR: 0-30)%. Technical efficiency was 95.1% (39/41), technical success was 82.9% (34/41). Primary AVF patency within 3, 6, and 12 months was 85.7%, 82.4%, and 77.8%, respectively. Conclusion. Transluminal balloon angioplasty has proven to be a safe and effective treatment for central venous stenosis and arteriovenous fistulas. Performing both primary and repeated TBA procedures in most cases allows prolonging the use of the existing permanent vascular access (AVF) without performing repeated operations, and thus allows for saving vascular resources in the future.

сосудистый доступ, стеноз центральной вены, гемодиализ, стеноз АВФ, баллонная ангиопластика, vascular access, central vein stenosis, hemodialysis, AVF stenosis, balloon angioplasty

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