Thrombosis of the arterio-venous fistula: thrombectomy or reconstruction?

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%)...