[Features of balloon angioplasty in the treatment of central vein stenosis in patients with arteriovenous fistula on programmed hemodialysis].

Objective: To analyze AVF patency rates after balloon angioplasty and palliative open surgery in patients with native AVF and central vein stenosis.

Material And Methods: The study included 39 patients who underwent percutaneous balloon angioplasty (main group) and 41 patients who underwent palliative interventions (comparison group): thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow reduction. All patients were diagnosed with stenosis of subclavian vein, innominate vein, inferior vena cava or multiple lesions.

Results: Primary annual patency rate in the main group was 15.4% [95% CI 6.2; 28.3], in the comparison group - 0% (=0.0011). Secondary annual patency rate was 66.7% [95% CI 49.6; 79.1] and 19.5% [95% CI 9.2; 32.7], respectively (<0.0001). In the main group, a strong negative correlation between primary patency rate and stenosis-free period was revealed (= -0.627 [95%CI -0.787; -0.388], <0.0001). We did not find such correlation in the comparison group (=0,049 [95% CI -0.262; 0.351], =0.7599). Thus, balloon angioplasty is less effective for delayed stenosis. This feature should be considered in planning vascular approach. Different primary and secondary patency rates in the comparison group indicate that AVF blood flow reduction is an effective palliative treatment.

Conclusion: Balloon angioplasty can significantly increase duration of AVF patency. Effectiveness of this procedure significantly depends on the period of manifestation of central vein stenosis. Balloon angioplasty cannot be considered a radical method in case of significant stenosis. This method only prolongs period for creation of new permanent contralateral vascular approach. Reduction of AVF blood flow can significantly reduce clinical severity of central vein stenosis and slightly extends the period of AVF patency.