grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2025-184-2-52-58grekov-2452Research ArticleВОПРОСЫ ОБЩЕЙ И ЧАСТНОЙ ХИРУРГИИPROBLEMS OF GENERAL AND SPECIAL SURGERYХирургическая реконструкция тромбированного постоянного сосудистого доступа для гемодиализа, сформированного синтетическим протезомSurgical reconstruction of a thrombosed permanent vascular access for hemodialysis formed by a vascular access grafthttps://orcid.org/0000-0003-0915-6733ЧерняковИ. С.CherniakovI. S.

Черняков Илья Сергеевич, врач сердечно-сосудистый хирург, отделение сосудистой хирургии (в том числе для трансплантации почки)

194291, Санкт-Петербург, пр. Луначарского, д. 45, корп. 1, лит. А

Cherniakov Ilia S., Cardiovascular Surgeon, Department of Vascular Surgery (including Renal Transplantation)

45, build. 1, lit. A, Lunacharsky ave., Saint Petersburg, 194291

chernyakovis@gmail.comhttps://orcid.org/0000-0001-8382-1127БедровА. Я.BedrovA. Ya.

Бедров Александр Ярославович, доктор медицинских наук, профессор кафедры хирургии госпитальной с клиникой, зав. отделением сосудистой хирургии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Bedrov Aleksandr Ya., Dr. of Sci. (Med), Professor of the Department of Hospital Surgery with Clinic, Head of the Department of Vascular Surgery

6-8, L’va Tolstogo str., Saint Petersburg, 197022

abedrov@gmail.comhttps://orcid.org/0000-0001-5997-3753ВахитовМ. Ш.VakhitovM. Sh.

Вахитов Мавлет Шакирович, доктор медицинских наук, профессор кафедры общей хирургии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Vakhitov Mavlet Sh., Dr. of Sci. (Med), Professor of the Department of General Surgery

6-8, L’va Tolstogo str., Saint Petersburg, 197022

mavlet.46@mail.ruhttps://orcid.org/0000-0003-0863-0309ВладимировП. А.VladimirovP. А.

Владимиров Павел Александрович, врач сердечно-сосудистый хирург, зав. отделением сосудистой хирургии (в том числе для трансплантации почки)

194291, Санкт-Петербург, пр. Луначарского, д. 45, корп. 1, лит. А

 

 

Vladimirov Pavel A., Cardiovascular Surgeon, Leningrad Regional Clinical Hospital, Head of the Department of Vascular Surgery (including Renal Transplantation)

45, build. 1, lit. A, Lunacharsky ave., Saint Petersburg, 194291

vladimirov.pavel@mail.ruЛенинградская областная клиническая больницаРоссияLeningrad Regional Clinical HospitalRussian FederationПервый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияPavlov UniversityRussian Federation20252706202518425258Copyright © Черняков И.С., Бедров А.Я., Вахитов М.Ш., Владимиров П.А., 20252025Черняков И.С., Бедров А.Я., Вахитов М.Ш., Владимиров П.А.Cherniakov I.S., Bedrov A.Y., Vakhitov M.S., Vladimirov P.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2452Введение

Введение. Проблема сохранения проходимости постоянного сосудистого доступа (ПСД) для проведения заместительной почечной терапии (зПТ) крайне актуальна из-за высокой частоты развития его тромбоза и необходимости выполнения повторных хирургических вмешательств с целью реконструкции или формирования нового доступа.

Цель

Цель. Оценить эффективность различных способов хирургической реконструкции ПСД, сформированного синтетическим протезом, при его тромбозе.

Методы и материалы

Методы и материалы. Выполнен ретроспективный анализ историй болезни 46 пациентов, оперированных в период с 2018 по 2022 г., у которых был диагностирован тромбоз ПСД. По поводу выявленного гемодинамически значимого стеноза протезно-венозного анастомоза проведена успешная реконструкция ПСД.

Результаты

Результаты. Медиана времени первичной проходимости доступов составила 21±13, 7 месяцев, а вторичной – 19±15, 6 месяцев. Медиана времени вторичной проходимости после тромбэктомии составила 9±7,5 месяцев, тромбэктомии в сочетании с пластикой зоны анастомоза – 10,3±9,1 месяцев, тромбэктомии с репротезированием – 14±12,9 месяцев, тромбэктомии с аутовенозным протезированием – 18±9,0 месяцев. Медиана времени кумулятивной проходимости доступов составила 41±27, 3 месяцев.

Заключение

Заключение. Выполнение реконструктивной операции при тромбозе ПСД позволяет не только восстановить проходимость последнего, но и значимо пролонгировать его функцию.

Introduction

Introduction. The problem of maintaining the patency of the permanent vascular access (PVA) for renal replacement therapy (RRT) is extremely relevant due to the high incidence of its thrombosis and the need for repeated surgical interventions to reconstruct or form a new access.

The objective was to evaluate the efficacy of different approaches to surgical reconstructions of the PVA formed by a vascular access graft in its thrombosis.

Methods and materials

Methods and materials. We performed a retrospective analysis of medical records of 46 patients operated on from 2018 to 2022 and who were diagnosed with PVA thrombosis. As for the revealed hemodynamically significant stenosis of the prosthetic venous anastomosis, a successful reconstruction of the PVA was performed.

Results

Results. The median time for primary graft patency was 21±13.7 months, and secondary one was 19±15, 6 months. The median time for secondary patency after thrombectomy was 9±7.5 months, thrombectomy combined with plasty of the anastomosis area was 10.3±9.1 months, thrombectomy with reprosthetics was 14±12.9 months, thrombectomy with autovenous replantation was 18±9.0 months. The median time for the cumulative graft patency was 41±27.3 months.

Conclusion

Conclusion. Reconstructive surgery for PVA thrombosis allows not only to restore the patency of the latter, but also significantly prolong its function.

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The authors declare that there are no conflicts of interest present.