A.V. MAKSIMOV^1,2, E.Sh. MAKARIMOV¹, A.K. FEYSKHANOV¹

¹Republic Clinical Hospital of the MH of RT, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064

²Kazan State Medical Academy ― Branch Campus of the RMACPE MOH Russia, 36 Butlerov Str., Kazan, Russian Federation, 420012

 Maksimov A.V. ― D. Med. Sc., Head of the Vascular Surgery Department №1, Associate Professor of the Department of Cardiology, Roentgen Endovascular and Cardiovascular Surgery, tel. +7-917-877-16-65, e-mail: maks.av@mail.ru

Makarimov E.Sh. ― Head of the Department of Roentgen Surgery Methods of Diagnostics and Treatment, tel. +7-917-887-010-10, e-mail: makarim@inbox.ru

Feyshanov A.K. ― Vascular Surgeon of the Vascular Surgery Department №1, tel. +7-987-296-06-42, e-mail: faygiz@mail.ru

Basing on the analysis of 329 patients with terminal renal failure, a classification of permanent vascular access pathology is proposed. Seven types of pathology can be distinguished: ischemia, aneurysmatic changes of access, limb venous insufficiency, high flow-syndrome with or without heart failure, thrombosis of the access, infectious necrotic complications and non-maturing fistula. Each of the pathologic processes can occur in case of damage to one part of the system — inflow pathology (38.0%), access pathology (42.9%) and outflow pathology (19.1%). The optimal treatment consists of a rational combination of open surgical and endovascular methods.

Key words: terminal renal failure, permanent vascular access, classification.

REFERENCES

1. De Almeida L.E., Dias F., de Sousa T. et al. Survival in haemodialysis: is there a role for vascular access? Nephrol. Dial. Transplant., 1997, vol. 12, p. 852.
2. Bibkov B.T., Tomilina N.A. Substitution therapy of terminal renal failure in the Russian Federation in 1998-2013. Report on the data of the Russian register of renal replacement therapy. Part One. Nefrologiya i dializ, 2015, vol. 17, no. 3, pp. 5-111 (in Russ.).
3. Sawant A., Mills P.K., Dhingra H. Increased length of stay and costs associated with inpatient management of vascular access failures. Semin. Dial., 2013, 26 (1), pp. 106-110.
4. US Renal Data System. USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; 2010.
5. Tordoir J., Canaud B., Haage P. et al. EBPG on Vascular Access. Nephrol. Dial. Transplant, 2007, May, 22 Suppl 2, pp. ii88-117.
6. III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am. J. Kidney Dis., 2001, Jan., 37.
7. Frank T., Keith D., Anton N. Complications of arteriovenous hemodialysis access: Recognition and management. J. Vasc. Surg., 2008, vol. 48, pp. 55-80.
8. Maksimov A.V., Feyskhanov A.K., Makarimov E.Sh., Zakirzhanov N.R., Feyskhanova L.I. The tendency of the development of vascular access surgery in patients undergoing program hemodialysis. Prakticheskaya meditsina, 2014, vol. 2, no. 4, pp. 83-85 (in Russ.).