Reconstructive operations in pathology of central veins, associated with vascular approach

Maksimov A.V.^1,2, Feiskhanov A.K.¹, Maksimov E.Sh.¹, Feiskhanova L.I.³

1) Vascular Surgery Department No1, Republican Clinical Hospital of the Health Ministry of the Republic of Tatarstan,
2) Chair of Cardiology, Roentgenendovascular and Cardiovascular Surgery, Kazan State Medical Academy of RF Health Ministry,
3) Kazan State Medical University, Kazan, Russia

Presented herein are the results of treatment of 28 patients with stenosis/occlusion of central veins undergoing replacement therapy by means of programmed haemodialysis for terminal renal failure. The clinical symptomatology in all patients manifested itself by chronic lymphovenous insufficiency of the upper limb, dysfunction of the vascular access (14 patients), thrombosis of the vascular approach (5 patients), venous hypertension of the brain (4 patients). 17 patients had aneurysms of the vascular approach in the zone of puncture.

In 18 cases for correction of the venous outflow we performed roentgenoendovascular angioplasty, including 3 cases in combination with stenting. Technical success amounted to 83.3% (15 of 18 cases). 13 patients underwent open reconstructive operations, including 5 cases of thrombectomy from the vein (in all cases failed one), in 8 cases bypassing operations (cross cephalic anterior jugular shunting – 5, subclavian-femoral bypass grafting – 1, transposition of the external jugular vein into the internal jugular vein – 1. In-hospital patency of bypasses amounted to 87.5% (7 shunts of 8).

The remote results were followed up within the terms up to 43 months (averagely 12.3±2.2 months). In the group of endovascular treatment more than half of patients (8 of 15) required secondary endovascular interventions. The cumulative requirements in re-do manipulations amounted to 52.4% during the first year and to 89.4% during the second year. The function of the approach was preserved in 93.3% of patients.

Of the seven shunts patent in the early postoperative period, occlusion occurred in three cases at 1, 5 and 13 months. The 1-year patency amounted to 50.0%. The function of the approach was preserved in 75.0% of cases.

KEY WORDS: pathology of central veins, haemodialysis, vascular approach, reconstructive operations, percutaneous balloon angioplasty.

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