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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ssmu</journal-id><journal-title-group><journal-title xml:lang="ru">Бюллетень сибирской медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Bulletin of Siberian Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-0363</issn><issn pub-type="epub">1819-3684</issn><publisher><publisher-name>Siberian State Medical University, the Ministry of Healthcare of the Russian Federation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20538/1682-0363-2019-3-164-174</article-id><article-id custom-type="elpub" pub-id-type="custom">ssmu-2414</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И ЛЕКЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEW AND LECTURES</subject></subj-group></article-categories><title-group><article-title>Открытые и эндоваскулярные оперативные вмешательства при стенозе периферических отделов фистульных вен</article-title><trans-title-group xml:lang="en"><trans-title>Open and endovascular surgery for stenosis of the peripheral regions of arteriovenous fistula</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Карданахишвили</surname><given-names>З. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Kardanakhishvili</surname><given-names>Z. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>аспирант, кафедра трансплантологии, нефрологии и искусственных органов,</p><p> 129110, г. Москва, ул. Щепкина, 61/2, корпус 6</p></bio><bio xml:lang="en"><p>Postgraduate Student, Department of Transplantology, Nephrology and Artificial Organs,</p><p>129110, Moscow, Shchepkina Str., 61/2, building 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5405-7887</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Зулькарнаев</surname><given-names>А. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Zulkarnaev</surname><given-names>A. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, гл. науч. сотрудник, хирургическое отделение трансплантологии и диализа,</p><p>129110, г. Москва, ул. Щепкина, 61/2, корпус 6</p></bio><bio xml:lang="en"><p>DM, Principal Researcher, Surgical Department of Transplantation and Dialysis,</p><p>129110, Moscow, Shchepkina Str., 61/2, building 6</p></bio><email xlink:type="simple">7059899@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Московский областной научно-исследовательский клинический институт (МОНИКИ) им. М.Ф. Владимирского</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Moscow Regional Research and Clinical Institute</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2019</year></pub-date><pub-date pub-type="epub"><day>27</day><month>10</month><year>2019</year></pub-date><volume>18</volume><issue>3</issue><fpage>164</fpage><lpage>174</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Карданахишвили З.Б., Зулькарнаев А.Б., 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder xml:lang="ru">Карданахишвили З.Б., Зулькарнаев А.Б.</copyright-holder><copyright-holder xml:lang="en">Kardanakhishvili Z.B., Zulkarnaev A.B.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://bulletin.ssmu.ru/jour/article/view/2414">https://bulletin.ssmu.ru/jour/article/view/2414</self-uri><abstract><p>Сосудистый доступ – краеугольный камень гемодиализа. При дисфункции сосудистого доступа значительно ухудшаются результаты лечения пациентов с хронической болезнью почек V стадии. Одной из наиболее частых причин дисфункции сосудистого доступа является стеноз периферического отдела фистульной вены. Несмотря на многообразие инициирующих факторов, морфологическим субстратом стенотического поражения фистульной вены (или артериовенозного анастомоза) в большинстве случаев является неоинтимальная гиперплазия. Стенотическое поражение фистульной вены сильно ассоциировано с повышенным риском тромбоза и утратой сосудистого доступа. Можно условно выделить четыре характерные локализации стеноза: артериовенозный или артериопротезный анастомоз, стеноз юкстаанастомотического сегмента фистульной вены, стеноз фистульной вены на протяжении «функционального» сегмента, стеноз «плечевой дуги».</p><p>Показаниями к оперативному лечению в подавляющем большинстве случаев являются нарушение функции сосудистого доступа и гораздо реже – клиническая симптоматика венозной недостаточности.</p><p>Известны различные методы открытой реконструкции стенозированного участка фистульной вены: резекция, протезирование синтетическим сосудистым протезом, протезирование или пластика стенки аутовеной, полное или частичное дренирование пристенотического сегмента вены и др. Постепенно набирает популярность альтернативный метод пластики стеноза при помощи эндоваскулярных вмешательств. В отличие от стенозов центральных вен, где эндоваскулярные вмешательства являются золотым стандартом, при стенозе периферических вен это лишь адъювантый метод. Осложнения при эндоваскулярных вмешательствах встречаются крайне редко.</p><p>Несмотря на то, что эндоваскулярные вмешательства имеют практически абсолютную вероятность технического успеха, первичная проходимость невысока и составляет примерно 50% через полгода. Использование непокрытых стентов не сопровождается увеличением первичной проходимости. Применение стент-графтов позволяет увеличить первичную проходимость, особенно при пластике «проблемных» стенозов в области протезовенозного анастомоза и плечевой дуги.</p><p>Множество вопросов, связанных с эндоваскулярными вмешательствами, остаются неразрешенными, что требует продолжения исследований в этом направлении. </p></abstract><trans-abstract xml:lang="en"><p>Vascular access is the cornerstone of hemodialysis. With vascular access dysfunction, the results of treatment of patients with stage 5 chronic kidney disease significantly deteriorate. One of the most common causes of vascular access failure is peripheral venous stenosis. Despite the variety of initiating factors, the morphological substrate of stenotic damage to the arteriovenous fistula (or arteriovenous anastomosis) in most cases is neointimal hyperplasia. Stenotic lesions of the arterivenous fistula are strongly associated with an increased risk of thrombosis and loss of vascular access. There are 4 typical localizations of stenosis: arteriovenous or arteriograft anastomosis, stenosis of the juxta-anastomotic segment of the fistula, stenosis of the functional segment of the fistula, and stenosis of the cephalic arc.</p><p>The most common indication for surgical treatment is vascular access failure; less common indications are clinical symptoms of venous insufficiency.</p><p>There are various methods of open reconstruction of the stenotic segment of the fistula vein: resection, prosthetics with a synthetic vascular graft, prosthetics or plastic repair of the autologous vein wall, complete or partial drainage of the prestenotic segment of the vein, etc. Currently an alternative method of stenosis repair using endovascular interventions is gaining popularity. In contrast to central vein stenosis, where endovascular interventions are the gold standard, in peripheral vein stenosis it is only an adjuvant method. Complications of endovascular interventions are extremely rare.</p><p>Despite the fact that endovascular interventions have almost absolute probability of technical success, the primary patency is not high and is about 50% in six months. The use of bare stents is not accompanied by an increase in primary patency. The use of stent-grafts can increase the primary patency, especially in the plastic repair of challenging stenoses of the graft-vein anastomosis or cephalic arch.</p><p>Many issues related to endovascular interventions remain unresolved, which requires further research. </p></trans-abstract><kwd-group xml:lang="ru"><kwd>сосудистый доступ</kwd><kwd>гемодиализ</kwd><kwd>стеноз</kwd><kwd>ангиопластика</kwd><kwd>артериовенозная фистула</kwd><kwd>сосудистый протез</kwd><kwd>стент</kwd></kwd-group><kwd-group xml:lang="en"><kwd>vascular access</kwd><kwd>hemodialysis</kwd><kwd>stenosis</kwd><kwd>angioplasty</kwd><kwd>arteriovenous fistula</kwd><kwd>vascular graft</kwd><kwd>stent</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015. 2017. 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