Surgical reconstruction of a thrombosed permanent vascular access for hemodialysis formed by a vascular access graft

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