Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula
Objective: to conduct comprehensive comparative analysis of the patency rate of native arteriovenous fistula (AVF) for central vein stenosis (CVS) after endovascular balloon angioplasty and palliative surgery. Materials and methods. The retrospective study included 80 patients with confirmed central...
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| Format: | Article |
| Language: | Russian |
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Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov
2020-04-01
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| Series: | Vestnik Transplantologii i Iskusstvennyh Organov |
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| Online Access: | https://journal.transpl.ru/vtio/article/view/1145 |
| _version_ | 1797871944428683264 |
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| author | Z. B. Kardanakhishvili A. B. Zulkarnaev B. V. Baykov V. A. Stepanov |
| author_facet | Z. B. Kardanakhishvili A. B. Zulkarnaev B. V. Baykov V. A. Stepanov |
| author_sort | Z. B. Kardanakhishvili |
| collection | DOAJ |
| description | Objective: to conduct comprehensive comparative analysis of the patency rate of native arteriovenous fistula (AVF) for central vein stenosis (CVS) after endovascular balloon angioplasty and palliative surgery. Materials and methods. The retrospective study included 80 patients with confirmed central vein stenosis: subclavian, brachiocephalic veins, inferior vena cava, or multiple lesions. The experimental group included 39 patients who underwent percutaneous balloon angioplasty. The control group included 41 patients who, for various reasons, did not do balloon angioplasty, but underwent palliative interventions: thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow-reducing surgical procedures. Results. Primary patency (time interval between the first intervention for CVS and the second intervention) in the experimental group was 61.5% [95% CI 44.5; 74.7] and 15.4% [95% CI 6.2; 28.3] at 6 and 12 months, respectively. In the control group, it was 39% [95% CI 24.3; 53.4] and 0% respectively. Hazard ratio (HR) 0.5337 [95% CI 0.3381; 0.8427], log-rank test p = 0.0011. No differences in functional primary patency (time interval between the start of using AVF and the first intervention for CVS) were found: 89.7% [95% CI 74.9; 96] and 30.8% [95% CI 17.3; 45.4] at 1 year and 3 years, respectively, in the experimental group, and 80.5% [95% CI 64.8; 89.7] and 24.4% [95% CI 12.7; 38.2] in the control group. There were no differences between the groups HR 0.7695 [95% CI 0.4952; 1.196], log-rank p = 0.2259. In the experimental group, strong negative correlation between primary patency and functional primary patency was detected: r = –0.627 [95% CI –0.787; –0.388], p < 0.0001. In the control group, no such correlation was found: r = 0.049 [95% CI –0.262; –0.351], p = 0.7599. Thus, the later CVS developed, the less effective balloon angioplasty was. Balloon angioplasty significantly increased duration of AVF use after first intervention for CVS (secondary patency): 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] at 6, 12 and 24 months, respectively in the experimental group. In the control group, it was 56.1% [95% CI 39.7; 69.6], 19.5% [95% CI 9.2; 32.7] and 0%. HR 0.4009 [95% CI 0.2481; 0.6477], log-rank p < 0.0001. Functional secondary patency (total duration of AVF use) was: 100%, 74.4% [95% CI 57.6; 85.3] and 12.8% [95% CI 4.7; 25.2] at 1, 3 and 5 years in the experimental group, and 95.1% [95% CI 81.9; 98.8], 36.6% [95% CI 22.3; 51] and 4.9% [95% CI 0.9; 14.5] in the control group. HR 0.5661 [95% CI 0.3598; 0.8906], log-rank p = 0.0067. Conclusions. 1. Central vein stenosis inevitably cuts vascular access from the ipsilateral side. 2. Balloon angioplasty allows to slightly prolong AVF use but it cannot radically change the long-term results of CVS treatment. 3. The outcome of balloon angioplasty greatly depends on the length of the period from the time the use of AVF started to the time CVS developed. 4. Multiple repeated balloon angioplasties are apparently justified in patients for whom creating a new vascular access might not be possible. 4. AVF volumetric blood flow velocity is an important factor determining the severity of CVS clinical manifestations and whether repeated surgical interventions are needed. |
| first_indexed | 2024-04-10T00:52:08Z |
| format | Article |
| id | doaj.art-9ae2643f16f543bc912a5fde9cfbb333 |
| institution | Directory Open Access Journal |
| issn | 1995-1191 |
| language | Russian |
| last_indexed | 2024-04-10T00:52:08Z |
| publishDate | 2020-04-01 |
| publisher | Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov |
| record_format | Article |
| series | Vestnik Transplantologii i Iskusstvennyh Organov |
| spelling | doaj.art-9ae2643f16f543bc912a5fde9cfbb3332023-03-13T10:37:26ZrusFederal Research Center of Transplantology and Artificial Organs named after V.I.ShumakovVestnik Transplantologii i Iskusstvennyh Organov1995-11912020-04-01221597110.15825/1995-1191-2020-1-59-71849Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistulaZ. B. Kardanakhishvili0A. B. Zulkarnaev1B. V. Baykov2V. A. Stepanov3War Veterans Hospital No. 2; M.E. Zhadkevich City clinical hospitalM.F. Vladimirsky Moscow Regional Research Clinical InstituteWar Veterans Hospital No. 2; Krasnogorsk city hospital No 1M.F. Vladimirsky Moscow Regional Research Clinical InstituteObjective: to conduct comprehensive comparative analysis of the patency rate of native arteriovenous fistula (AVF) for central vein stenosis (CVS) after endovascular balloon angioplasty and palliative surgery. Materials and methods. The retrospective study included 80 patients with confirmed central vein stenosis: subclavian, brachiocephalic veins, inferior vena cava, or multiple lesions. The experimental group included 39 patients who underwent percutaneous balloon angioplasty. The control group included 41 patients who, for various reasons, did not do balloon angioplasty, but underwent palliative interventions: thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow-reducing surgical procedures. Results. Primary patency (time interval between the first intervention for CVS and the second intervention) in the experimental group was 61.5% [95% CI 44.5; 74.7] and 15.4% [95% CI 6.2; 28.3] at 6 and 12 months, respectively. In the control group, it was 39% [95% CI 24.3; 53.4] and 0% respectively. Hazard ratio (HR) 0.5337 [95% CI 0.3381; 0.8427], log-rank test p = 0.0011. No differences in functional primary patency (time interval between the start of using AVF and the first intervention for CVS) were found: 89.7% [95% CI 74.9; 96] and 30.8% [95% CI 17.3; 45.4] at 1 year and 3 years, respectively, in the experimental group, and 80.5% [95% CI 64.8; 89.7] and 24.4% [95% CI 12.7; 38.2] in the control group. There were no differences between the groups HR 0.7695 [95% CI 0.4952; 1.196], log-rank p = 0.2259. In the experimental group, strong negative correlation between primary patency and functional primary patency was detected: r = –0.627 [95% CI –0.787; –0.388], p < 0.0001. In the control group, no such correlation was found: r = 0.049 [95% CI –0.262; –0.351], p = 0.7599. Thus, the later CVS developed, the less effective balloon angioplasty was. Balloon angioplasty significantly increased duration of AVF use after first intervention for CVS (secondary patency): 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] at 6, 12 and 24 months, respectively in the experimental group. In the control group, it was 56.1% [95% CI 39.7; 69.6], 19.5% [95% CI 9.2; 32.7] and 0%. HR 0.4009 [95% CI 0.2481; 0.6477], log-rank p < 0.0001. Functional secondary patency (total duration of AVF use) was: 100%, 74.4% [95% CI 57.6; 85.3] and 12.8% [95% CI 4.7; 25.2] at 1, 3 and 5 years in the experimental group, and 95.1% [95% CI 81.9; 98.8], 36.6% [95% CI 22.3; 51] and 4.9% [95% CI 0.9; 14.5] in the control group. HR 0.5661 [95% CI 0.3598; 0.8906], log-rank p = 0.0067. Conclusions. 1. Central vein stenosis inevitably cuts vascular access from the ipsilateral side. 2. Balloon angioplasty allows to slightly prolong AVF use but it cannot radically change the long-term results of CVS treatment. 3. The outcome of balloon angioplasty greatly depends on the length of the period from the time the use of AVF started to the time CVS developed. 4. Multiple repeated balloon angioplasties are apparently justified in patients for whom creating a new vascular access might not be possible. 4. AVF volumetric blood flow velocity is an important factor determining the severity of CVS clinical manifestations and whether repeated surgical interventions are needed.https://journal.transpl.ru/vtio/article/view/1145central vein stenosisarteriovenous fistulahemodialysis vascular accessballoon angioplastypercutaneous transluminal angioplastyendovascular surgery |
| spellingShingle | Z. B. Kardanakhishvili A. B. Zulkarnaev B. V. Baykov V. A. Stepanov Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula Vestnik Transplantologii i Iskusstvennyh Organov central vein stenosis arteriovenous fistula hemodialysis vascular access balloon angioplasty percutaneous transluminal angioplasty endovascular surgery |
| title | Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula |
| title_full | Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula |
| title_fullStr | Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula |
| title_full_unstemmed | Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula |
| title_short | Ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula |
| title_sort | ambiguous results of balloon angioplasty for central vein stenosis in hemodialysis patients with native arteriovenous fistula |
| topic | central vein stenosis arteriovenous fistula hemodialysis vascular access balloon angioplasty percutaneous transluminal angioplasty endovascular surgery |
| url | https://journal.transpl.ru/vtio/article/view/1145 |
| work_keys_str_mv | AT zbkardanakhishvili ambiguousresultsofballoonangioplastyforcentralveinstenosisinhemodialysispatientswithnativearteriovenousfistula AT abzulkarnaev ambiguousresultsofballoonangioplastyforcentralveinstenosisinhemodialysispatientswithnativearteriovenousfistula AT bvbaykov ambiguousresultsofballoonangioplastyforcentralveinstenosisinhemodialysispatientswithnativearteriovenousfistula AT vastepanov ambiguousresultsofballoonangioplastyforcentralveinstenosisinhemodialysispatientswithnativearteriovenousfistula |